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CPG # T0: 4ICE OF REVENUE AND RECOVERY • O �� <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL O <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ARTISTIC ORNAMENTAL IRON WORKS <br /> C/O NAME GUARANTOR SSN <br /> ALEX& ERNESTO GONZALEZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2228 N WILSON WAY STOCKTON CA 95205 209-598-6673 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1636 S AMERICAN ST STOCKTON CA 95206 209-465-7725 <br /> USER REFERENCE NO. BILL kTAT CYCLE STATUS DATE BMd CBM INT MONTHLY PAY AMT I <br /> PYMT I PR B <br /> 2036 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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $28.50 <br /> State Surcharge Fee $24.00 <br /> Sm Hw Gen <5 Tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $763.50 <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 /> ARTISTIC ORNAMENTAL IRON WORKS 209-598-6673 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2228 N WILSON WAY STOCKTON CA 95205 <br /> SPOUS9 CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO AUTO LIC NO <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ARTISTIC ORNAMENTAL IRON WORKS 209-598-6673 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> CA <br /> 2228 N WILSON WAY STOCKTON 5205 <br /> PREPARED BY I CHECKED By JDATE S d 9 COL. 20 (3W) <br />