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CPh # y TO: 9ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ABC RADIATOR 17 <br /> C/O NAME GUARANTOR SSN <br /> EDWARD FORTUNE <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 601 S WILSON WAY STOCKTON CA 95205 209-463-7401 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-463-7401 <br /> USER REFERENCE NO. IBILLI STA CYCLEI STATUS DATEI BMd CBMCI INT I MONTHLY PAY AMT <br /> DUE DATE I TERM nATF <br /> 942 HAZMAT 3/15/08 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIOR PIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CH <br /> NO RGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2008 Hmmp Annual Fee $240.00 <br /> 6 Chems @ $15.00 Each $90.00 <br /> 10% Late Charge $33.00 <br /> State Service Fee $24.00 <br /> Sm Hw Gen <5 Tons $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $813.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ABC RADIATOR 209-463-7401 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 601 S WILSON WAY STOCKTON CA 95205 <br /> 9£9B8$ CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. I DOB I DR LIC NO I AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ABC RADIATOR 209-463-7401 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 601 S WILSON WAY STOCKTON CA 95205 <br /> PREPARED BY CHECKED BY DATE 1%2aF, COL. 20 (3188 <br />