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1'.0. Box 806 <br /> r-- Colton, CA 92324-0806 <br /> ML Toll Free: 888.641.3940 <br /> v4� GISTICSPhane: 909.54G.93S4•Fax: 909.546.1546 <br /> DATE INVOICE NUMBER <br /> "PROTECTING HUMAN HEALTH AND THE ENVIRONMENT" 1 4 5 ( 4 t1 j <br /> www.environmentallogistics.org CUSTOMER NUMBER <br /> [ADDRESS <br /> USTOMER NAME PHONE NO. BILL TO PHONE NO. <br /> n .S t. 949-233-2789 1r RNI j t � _: .1 <br /> 46 CLING ADDRESS <br /> 2804 FREMONEEST,a- N- IM .Bf R`€- ST 9 CALLF, .BELL A <br /> CITY/STATE/ZIP -' CITY STATE!ZIP <br /> ST OCK--] scorr XXX -- W7'Utwl. CA 95219 RANC110 SAN'T'A NHA.RGARIT k CA 9268 <br /> SALES REP, SITE CONTACT C.O.D. ON ACCOUNT PURCHASE ORDER NO. BILLING CONTACT REQUESTED BY <br /> rERIAL DESCRIPTION MANIF ST . * ` <br /> OIVS17E 8.I if <br /> 1 <br /> !I <br /> V Pit_ 17 X 55 NONT H-HAy, SOL 7V FIBS' NIH1.4574-N <br /> NONT HAZ Wr FER TO <br /> I <br /> i <br /> I <br /> A 15%Environmental 1 Energy&Securities charge applies to all invoice totals. <br /> i <br /> FACILITY NAME Environmental Logistics DRIVER START TIME: <br /> I <br /> ADDRESS 140 West Monte Avenue TIME LEFT YARD: �. ; • f)�, i <br /> Bloomington;CA 92316 JOB STARTTIME: <br /> EPA ID NUMBER CAR000172460'_ �•. JOB END,TIME!' T '- .- <br /> EPA ID NUMBER CAR000172478 j DRIVER END TIME: <br /> DRIVER'S SIGNATURE ( I <br /> It is the generator's responsibility to-'correctly identity chemical composition. <br /> If material is rejected by disposal site,generator agrees to pay all testing,disposal&transportation charges. SUB TOTAL <br /> Invoice is subject to a 1.5%interest rate on past due amount. <br /> Your signature below acknowledges that you have read the state required notifications on the back of this document. <br /> RECEIVED BY: PRINT NAME <br /> TOTAL* . <br /> I <br />