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Page: 1 of 1 <br /> • Stericycle® <br /> 40,01000 <br /> Manteca Care & Rehab <br /> Experts in Infection Control and Healthcare Compliance Services Accounts Payable <br /> • <br /> 9188 Glenoaks Blvd,Suite 300 �� 410 Eastwood Ave <br /> Sun valley CA 91352 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 03/31/2004 0002730991 6059477 Net 30 Days <br /> Iv1ANIFEST <br /> DATI^ QTY D8SCREPTION WIGHT(L j PRIGC El/M I-t Teti <br /> NUMBER:, <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 /> 03/15/2004 MDFROO142F 1.00 12 Cal(Pharm)' 0 Tare Wt. 0.00 0.000 EA 0.00 <br /> 03/22/2004 MDFR0014WZ 1.00 44 Gal Tub(Bio), CT 12.7 lb 20.90 0.000 EA I 0.00 <br /> 03/29/2004 MDFR0015R8 1.00 44 Gal Tub(Bio), CT 12.7 lb 15.90 0.000 EA 0.00 <br /> SITE-SUBTOTAL-AMT: $0.00 <br /> SITE-TOTAL-TAX: $0.00 <br /> SITE-TOTAL-AMT: $0.00 <br /> _.. . ... <br /> CtartertfT=3i3 Bays >: 31,60 Days £1 90:Days Quer 90 Days <br /> 825.00 0.00 1 0.00 0.00 0.00 INVOICE TOTAL: $0.00 <br /> MESSAGB:EENT@R>: <br /> Due to rising fuel costs, your invoice may reflect a temporary energy charge. <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.PTP 00003017 1 00003655 DETACH AT PERFORATION AND RETURN BOTTOM PORTION WITH YOUR PAYMENT <br /> ❑ American Express ❑ VISA ❑ MasterCard ❑ Discover <br /> Stericycle® <br /> •�•• Experts in Infection Control and Healthcare Compliance Services Credit Card Account Number Expiration Date <br /> Signature <br /> 9188 Glenoaks Blvd,Suite 300 <br /> Sun Valley CA 91352 <br /> 0006059477 0002730991 0000000000 3 030007 <br /> F1 11 1M[1.TTANC Please write Amount Paid below <br /> Il�lrnl�ln�lln�llnll�nrllEEEEllrllnlu�lnElllluullEEl © 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 IIEEIEEI�I�IIll1111 111 IEI�Ill�l�l111 <br /> 00003017 43 9509 <br /> Invoice Customer Date: InvoiceAmount <br /> Number: 0002730991 Number: 6059477 03/31/2004 Amount: $0.00 <br /> Paid: $ <br />