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Page: 1 of 1 <br /> e Stericycle® M <br /> Manteca Care & Rehab <br /> 440 <br /> • Experts in Infection Control and Healthcare Compliance Services Accounts Payable <br /> 0410 Eastwood Ave <br /> 9188 Glenoaks Blvd,Suite 300 <br /> NV <br /> Sun Valley CA 91352Q Manteca CA 953363167 <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 04/02/2004 0002733026 6059477 Net 30 Days <br /> DATE MANlI SSI QTY E7ir5C131PTCON WEIGHT(L8) PF110E E1lM 1 t}T'.A 1 <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 /> 04/05/2004 1 MDFROO16KJI 1.00 1 44 Gal Tub Bio , CT 12.7 lb 1 23.40 1 0.000 EA 1 0.00 <br /> SITE-SUBTOTAL-AMT: $0.00 <br /> SITE-TOTAL-TAX: $0.00 <br /> SITE-TOTAL-AMT: $0.00 <br /> Curter f 1 3�.13ays 3i-80 Dais SI O Days Uver.90 E ays <br /> 825.00 1 0.00 0.00 0.001 0.00 INVOICE TOTAL: $0.00 <br /> TEfis: <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 00003656 DETACH AT PERFORATION AND RETURN BOTTOM PORTION WITH YOUR PAYMENT <br /> - -.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Ll American Express ❑ VISA ❑ MasterCard ❑ Discover <br /> Stericycle® <br /> • Experts in Infection Control and Healthcare Compliance Services Credit Card Account Number Expiration Date <br /> 001, Signature <br /> • 9188 Glenoaks Blvd,Suite 300 <br /> Sun Valley CA 91352 <br /> 0006059477 0002733026 0000000000 3 030009 <br /> [REMITTANCE Please write Amount Paid below <br /> 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 953363167 <br /> Invoice Customer Date: Invoice Amount <br /> Number: 0002733026 Number: 6059477 04/02/2004 Amount: $0.00 Paid: $ <br />