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CPG # TO: "FICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL CO P <br /> n/]ACCOUNT NO. DEPT. NO. REFERRAL V <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> DURATEC <br /> C/O NAME GUARANTOR SSN <br /> GARY DURAN <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> DURATEC P.O. BOX 1207 MANTECA CA 95336 209-858-8359 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1022 SWAN DRIVE MANTECA CA 95337 209-858-5359 <br /> ROB <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM(fCBMd INT MONTHLY PAY AMT PYMT <br /> 542 HAZMAT 3/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> tin <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 5 Chems @ $15.00 Each $75.00 <br /> 10% Late Charge $31.50 <br /> State Surcharge Fee $24.00 <br /> TOTAL $370.50 <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 /> DURATEC 209-858-8359 <br /> EMPLOYER STREET CITY ST I ZIP CODE <br /> 293 E WETMORE ST MANTECA CA 95337 <br /> SPAUSItr CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DURATEC 209-858-8359 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 293 E WETMORE ST MANTECA CA 952!37 <br /> PREPAREDB - e CHECKED BY 12ATE i/ Z O� COL. M(3/BB) <br />