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Page: 1 of 1 <br /> -c (SD <br /> Experts in Infection Control and Healthcare Compliance Services Manteca Care & Rehab <br /> Accounts Payable <br /> 9188 Glenoaks Blvd,suite 300 410 Eastwood Ave <br /> Sun valley CA 91352 <br /> INVOICE, Manteca CA 95336-3167 <br /> FOR CUSTOMER FOR PICK-UP INVOICE DATE INVOICE NUMBER CUSTOMER NUMBER TERMS <br /> SERVICE INFORMATION <br /> CALL 800-953-9324 CALL 800-953-9324 03/01/2004 0002673116 6059477 Net 30 Days <br /> DA(M1U&I1F8EESRT.> <br /> pt~SCFtPTf0 QTY ATE (t_B) PRtCE L!!M TOTAI <br /> Site: 002 Manteca Care & Rehab <br /> 410 Eastwood Ave, Manteca, CA 95336-3167 <br /> WEIGHMASTER CERTIFICATE:This is to certify that the following described commodity was weighed,measured or counted by a weighmaster,whose signature is on this certificate, <br /> who is a recognized authority of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California Business and Professions Code, <br /> administered by the Division of Measurement Standards of the California Department of Food and Agriculture. <br /> Commodity:Medical Waste;Weighed at:Stericycle,Inc.,4135 W Swift Ave,Fresno,CA 93722 Terry Shain Deputy Weighmaster <br /> 02/09/2004 MDFROOOZWI 1.00 1 44 Gal Tub Bio , CT 12.7 lb 32.40 0.000 EA 0.00 <br /> 03/01/2004 1.00 Steri-Safe Standard-Monthly 0.00 825.000 EA 825.00 <br /> SITE-SUBTOTAL.-AMT: $825.00 <br /> SITE-TOTAL-TAX: $0.00 <br /> SITE-TOTAL-AMT: $825.00 <br /> I INVO'CE» _ 1A-Av.zb73i/,6 I <br /> I DEPT a ACCT � Ar�-s�..c;l_`N f—o <br /> I <br /> t ' , 51430 V. x�viat 90 Bays <br /> 0.00 1 0.00 INVOICE TOTAL: $825.00 <br /> TOT, Zr?.CX <br /> R� �- <br /> AP tea`:;L <br /> CERTIFICATION: THE MATERIAL LISTED ON THE MANIFEST #'(S) DETAILED ABOVE (INFECTIOUS MEDICAL WASTE) HAS BEEN TREATED IN ACCORDANCE <br /> WITH THE REQUIREMENTS OF FEDERAL, STATE, AND LOCAL REGULATIONS GOVERNING THE TREATMENT OF SUCH WASTE. A COPY OF THIS <br /> CERTIFICATE.,APPLICABLE MANIFESTS,AND THE APPROPRIATE LOGS WILL REMAIN ON FILE WITH THE COMPANY. <br /> STE073 STE001 STE00102.RTP 00000449 1 00000442 DETACH AT PERFORATION AND RETURN BOTTOM PORTION WITH YOUR PAYMENT <br /> - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - <br /> ❑ American Express ❑ VISA ❑ MasterCard ❑ Discover <br /> Experts in Infection Control and Healthcare Compliance Services Credit Card Account Number Expiration Date <br /> 9188 Glenoaks Blvd,Suite 300 Signature <br /> Sun Valley CA 91352 <br /> 0006059477 0002673116 0000082500 3 030001 <br /> Please write Amount Paid below <br /> IleleeeleleeelleeelleelLeeelleeeellelleJeeeleeelllleeeelleel PLEASE STERICYCLE INC <br /> Manteca Care & Rehab SEND PO BOX 79145 <br /> Accounts Payable PAYMENT PHOENIX AZ 85062-9145 <br /> 410 Eastwood Ave TO <br /> Manteca CA 95336-3167 Ileeleelelelleeeelleseal.ll�leee®elleleeleleleeleeleleleeeelll <br /> 00000449 42 0272 <br /> Invoice Customer Date: Invoice Amount <br /> Number: 0002673116 Number: 6059477 03/01/2004 Amount: $825.00 <br />