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CPG'# TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO REFERRAL0 PD <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. BILL TAT CYCLE STATUS DATE I BMI CBM INT MONTHLY PAY AMT I IF:PYMT nATP I PROB <br /> 542 HAZMAT 3/20/10 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENTnon 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 /> 230 026000.0 2010 Hazmat Fee $315.00 <br /> State Surcharge Fee $24.00 <br /> 1 64 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $31.50 <br /> Correction To A Charge -$33.00 <br /> TOTAL $362.50 <br /> GUARANTOR <br /> DOB DR LIC N: AUTO LIC NO <br /> PRIOR STREET CITYST ZIP CODE <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 /> SPOUS& CO—OWNER <br /> I.AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I 1 I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DURATEC 209-858-8359 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 293 E WETMORE ST MANTEL CA 95337 <br /> REPARED BY CHECKED B DATE _1//C) I COL. ZO (IM) <br />