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', • Stericycle, Inc. PAQE-1 o%1 i <br /> 1AN5 Polo Trail Dr, Suite 201 <br /> ni tericycle° dWForest, IL 60045 ICE DATE 10/01/2004 <br /> 019 SOICE NUMBER 0002960332 <br /> ..0 CUSTOMER NUMBER 6059477 <br /> 'v Experts in Infection Control and Healthcare Compliance Services ;INVOICE AMOUNT <br /> s <br /> C3 BY 10/31/2004 $836.00 <br /> C3 FOR CUSTOMER SERVICE <br /> a-- MANTECA CARE&REHAB sss-STERI-CALL !CURRENT C $1,672.00 <br /> ACCOUNTS PAYABLE866-783-7422 1-30 DAYS $88.68 <br /> 0 410 EASTWOOD AVE ,31-60 DAYS $0.00 <br /> MANTECA,CA 95336-3167 FOR PICK-UP INFORMATION <br /> C3 61-90 DAYS $0.00 <br /> It- 41111111110 800-MED-WASTE <br /> OVER 90 DAYS $0.00 <br /> 800-633-9278 c,261OA' <br /> 3111 1-U742"1 CIOV9W2M000618 <br /> WEIGHMASTER CERTIFICATE: This is to certify that the following described commodity was weighed,measured,or counted by a weighmaster,whose signature <br /> is on this certificate,and who is a recognized authority of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the <br /> California Business and Professions Code,administered by the Division of Measurement Standards of the California Department of Food and Agriculture. <br /> CERTIFICATION:The material listed on the manifest#(s)details below(infectious medical waste)has been treated in accordance with the requirements of federal,state,and local <br /> regulations governing the treatment of such waste.A copy of this certificate,applicable manifests,and the appropriate logs will remain on file with the company. <br /> MANIFEST/ QUANTITY/ <br /> DATE ORDER NUMBER CONTAINERS DESCRIPTION WEIGHT PRICE TOTAL <br /> Site 002: Manteca Care&Rehab,410 Eastwood Ave,Manteca,CA 95336-3167 <br /> Commodity Medical Waste;Weighed at Stericycle,Inc.,4135 W Swift Ave,Fresno,CA 93722. Tom Stalberger,Deputy Weightmaster <br /> 10/01/2004 1.00 Monthly Fuel Charge 0.00 LB $11.000 EA $11.00 <br /> 10/01/2004 1.00 Steri-Safe Standard-Monthly 0.00 LB $825.000 EA $825.00 <br /> Site 002:SUB TOTAL $836.00 <br /> Site 002:TAX TOTAL $0.00 <br /> to 002: TOTAL $836.00 <br /> FACILITY <br /> INVOICE# O Z (ab Z- <br /> GL/MONTH I VOICE AMOUNT DUE BY 90131/2004 $836.00 <br /> ACCT# AMOUNT <br /> ZgCl <br /> TOTAL 5 6. 00 <br /> APPROVAL <br /> PLEASE DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE <br /> AMOUNT ENCLOSED INVOICE AMOUNT DUE BY 10/31/2004 <br /> $ $836.00 <br /> CUSTOMER NUMBER DATE INVOICE NUMBER <br /> //� 6059477 10/01/2004 0002960332 <br /> 09 Ste r I C J c l e e CHECK CARD USING FOR PAYMENT <br /> ®®® Stericycle, Inc. MSA SECURITY <br /> 13975 Polo Trail Dr, Suite 201 ❑MASTERCARD ODISCOVER ❑VISA 13 AMERICAN EXP CODE <br /> Lake Forest, IL 60045 CARD NUMBER EXP.DATE <br /> RETURN SERVICE REQUESTED SIGNATURE PRINTED NAME <br /> 0006059477 0002960332 0000083600 3 030007 <br /> ADDRESSEE: REMIT TO: <br /> 1111n11111111111111111111111111111loll I1ielo11111111111111lo1 111111111111111111111[loll ail11111loilelt1l111111111I1Liloellll <br /> MANTECA CARE&REHAB STERICYCLE, INC. <br /> ACCOUNTS PAYABLE P.O. BOX 79145 <br /> 410 EASTWOOD AVE <br /> MANTECA,CA 95336-3167 PHOENIX, AZ 85062-9145 <br /> lililloeiillollleelilieiiloleii11ie11iieililloele'leleil'ale'llelel p�p�p I,'I q I'I' ,'p� �nry p''�pl� <br /> 31111-U742'1 CIOV9W2M000618 1 CIOVER,10:1.1 1IBM/11111111 ill Illll1111111111111111111liimiiuliliiml Ilp <br />