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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY ACCOUNT NO. DEPT. NO026000.0. REFERRAL <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> JUNCTION PETRO LLC <br /> C/O NAME GUARANTOR SSN <br /> PRITPAL DHILLON <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> JUNCTION PETRO LLC 3032 WATERLOO RD STOCKTON CA 95205 916-865-8616 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 44 CASTLE HILL CT ROSEVILLE CA 95678 916-865-8616 <br /> USER REFERENCE NO. BILL TAT ICYCLE STATUS DATE BMd CBMI INT MONTHLY PAY AMTPROB <br /> 14196 HAZMAT 1.3/20/10 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> Don <br /> SERVICE DATE-. DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Kin <br /> 230 026000.0 Sm Hw Gen <5tons/yr $213.00 Hazmat Penalty Fee $63.00 <br /> 2009 & 2010 Hazmat Fee $630.00 Permit Fee Penalt $1013.00 <br /> Ust State Surcharge Fee $45.00 <br /> Additional Ust $250.00 <br /> Ust Facility& 1 Tank $550.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> TOTAL 1 $2813.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JUNCTION PETRO LLC 916-865-8616 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3032 E WATERLOO RD STOCKTON CA 95205 <br /> SPAFJSB CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> 1 I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JUNCTION PETRO LLC 916-865-8616 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3032 E WATERLOO RD ST CA 95205 <br /> REPARED BY ICHFCKFDOY JDATE COL. 10M) <br />