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® AWricycle, Inc. PAGE: 1_of . <br /> �,� o 75 Polo Trail Dr, Suite 201 101200 <br /> ni VOICE DATE 1 <br /> ake Forest, IL 60045 INVOICE NUMBER 0003013743 <br /> ru CUSTOMER NUMBER 6059477 <br /> w <br /> ® Experts in Infection Control and Healthcare Compliance Services IINVOICE AMOUNT DU <br /> C3 BY 12/01/2004 4.50 <br /> C3 FOR CUSTOMER SERVICE <br /> U_ MANTECA CARE&REHAB 866-STERI-CALL CURRENT $984.50 <br /> 0 ACCOUNTS PAYABLE 866-783-7422 1-30 DAYS $0.00 <br /> 0 410 EASTWOOD AVE 31-60 DAYS $0.00 <br /> MANTECA,CA 95336-3167 FOR PICK-UP INFORMATION 61-90 DAYS <br /> $0.00 <br /> E 800-MED-WASTE OVER 90 DAYS $0.00 <br /> 800-633-9278 61261 OA <br /> 31111-U742`1DC12UCWK000621 <br /> WEIGHMAS TER CERTIFICATE: This is to certify that the following described commodity w Is 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 WSwiftAve,Fresno,CA 93722 Tom Stalberger,Deputy Weightmester <br /> 11/01/2004 1.00 Monthly Fuel Charge 0.00 LB $11.000 EA $11.00 <br /> 11/01/2004 1.00 Steri-Safe Standard-Monthly 0.00 LB $973.500 EA $973.50 <br /> Site 002:SUB TOTAL $984.50 <br /> FACILITY y-�(/ - ite002:TAX TOTAL $o a <br /> INVOICE it 7 ite 002: TOTAL $984.50 <br /> GL/MONTH q� O <br /> ACCT# AMOUNT <br /> O VOICE AMOUNT DUE BY 1210112004 $984.50 <br /> TOTAL <br /> APPROVAL <br /> L PLEASE DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE <br /> AMOUNT ENCLOSED INVOICE AMOUNT DUE BY 12101/2004 <br /> $984.50 <br /> ® CUSTOMER NUMBER DATE INVOICE NUMBER <br /> 00® Jterl�+°yCl@® 6059477 11/01/2004 0003013743 <br /> CHECK CARD USING FOA PAYMENT <br /> Stericycle, Inc. HSA <br /> ® SE <br /> 13975 Polo Trail Dr, Suite 201 ❑ <br /> MASTERCARD❑DISCOVER ❑VISA AMERICAN EXPCODE <br /> SECURITY <br /> Lake Forest, IL 60045 CARD NUMBER EXP DATE <br /> RETURN SERVICE REQUESTED SIGNATURE PRINTED NAME <br /> 0006059477 00030113743 0000098450 3 030007 <br /> ADDRESSEE: tt REMIT TO: tt <br /> Ilm�nmllln100nm1�nl0mnmllmmmll�Illmmlmnlum����mlmm�Imml (Inlmm'mlel'mmmmlluu'I�Im0lmmmmllminlmlminlmm0mlm�mumi« <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 /> 11.11...11h.111.1111.11.11.111.1. 111.11. 11.111 <br /> 31111-U742'1DC12UCWK000621 1DC12XWG7:1.1 ���I�'�II�fl��u��N1IINllllliptl �IWIIB iM�Nli@ <br />