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CPG # TO: OFFICE REVENUE AND RECOVERY ACCC OUNT TRANSMITTALCopy <br /> ACCOUNT NO. DEPT. NO. REFERRAL <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 /> USER REFERENCE NO. IBILL FAT ICYCLE ISTATUS DATEI BMd CBM INT MONTHLY PAY AMTYMT <br /> P <br /> 542 HAZMAT 1.3/20/11 <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 /> NO <br /> 230 026000.0 2011 Hazmat Fee $270.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 494vdn Ab <br /> Hazmat Penalty Fee $27.00 AV A PA <br /> TOTAL $346.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST I ZIP CODE <br /> 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 95337 <br /> SSOW" 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 I ST ZIP CODE <br /> 293 E WETMORE STN E n CA 95337 <br /> REPARED BYCHECKED BY DATE 5 7 // COL. 20 (else) <br />