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° INVOICE DATE 01/31/2011 <br /> StericycleINVOICE NUMBER 3001272629 <br /> f ° Protecting People,Reducing Risk CUSTOMER NUMBER 6109737 <br /> TRACY CONVALESCENT&REHAB <br /> ACCOUNTS PAYABLE For billing,scheduling or customer service: <br /> 545 WEST BEVERLY PLACE (866)783-7422 <br /> TRACY,CA 95376 ■ Hours:(Mon-Fri)7:00 AM-7:00 PM CST <br /> CustomerCare@Stericycle.com <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 <br /> certificate,and 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 /> ACCOUNT SUMMARY <br /> DESCRIPTION DATE AMOUNT TOTAL <br /> PREVIOUS BALANCE $1,062.73 <br /> CURRENT ADJUSTMENTS ($1,624.50) <br /> Payment-Ref#020173 01/04/2011 ($246.42) <br /> Payment-Ref#020185 01/04/2011 ($230.66) <br /> Payment-Ref#IV011911 01/19/2011 ($585.65) <br /> Payment-Ref#020053 01/25/2011 ($561.77) <br /> CURRENT INVOI RGES(SEE REVERSE SIDE FOR DETAILS) $500.96 <br /> EDIT BALANCE ($60.81) <br /> CERTIFICATION: The material listed on the manifest(s)(infectious medical waste)has been treated in accordance with the requirements of federal,state,and local regulations governing the <br /> treatment of such waste A copy of this certificate,applicable manifests,and the appropriate logs will remain on file with the company. For customers in AZ,MO,NM,NY,PA,PR,and WI,this <br /> invoice also serves as a certification of destruction. <br /> Account History <br /> Current 1-30 days 31-60 days 61-90 days 90+days Total Account <br /> Past Due Past Due Past Due Past Due Balance <br /> ($60.81) $0.00 $0.00 $0.00 $0.00 ($60.81) <br /> PLEASE DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE. TO ENSURE TIMELY POSTING OF YOUR PAYMENT PLEASE ALLOW 5 DAYS FOR MAILII <br /> INVOICE NUMBER INVOICE DATE CUSTOMER NUMBER <br /> 3001272629 01/31/2011 _- 6109737 <br /> ® ® StericyCle° CREDIT BALANCE ($60.81) <br /> ® STERICYCLE, INC. TOTAL AMOUNT ENCLOSED $ <br /> 28161 N. KEITH DRIVE AMERIUW <br /> LAKE FOREST, IL 60045 WSA EEIRIM SECURITY CODE <br /> CARD NUMBER EXP DATE <br /> — If account or contact information has changed please <br /> --... check box and fill out back portion of coupon SIGNATURE PRINTED NAME <br /> 0006109737 3001272629 0000050096 3 030002 <br /> ADDRESSEE: REMIT TO: <br /> I�s�u�li�in�le��r��e�lrrerIIIIIrnenI IIIIIIIIIIIIIIIIIIr��) I��u�ll�uoe�t'�r�ee�lurenl�r'��r�n(r'rOrr�n�r'r�nrlr�r� <br /> Rel':033STUB4003143-2 <br /> TRACY CONVALESCENT&REHAB STERICYCLE, INC. <br /> ACCOUNTS PAYABLE P.O. BOX 9001589 <br /> 545 WEST BEVERLY PLACE <br /> TRACY,CA 95376 LOUISVILLE, KY 40290-1589 <br />