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'ent by: GAMBRO 9498315035; 06/11 /2005 4:38AM; #686; Page 17/24 <br /> Steric cle, Inc. <br /> S�'�ric C1e ,3975 Pada Trail r, Suite 201 <br /> Lake Forest,I# 60048 ru <br /> PAGE: I <br /> Lc <br /> INVOICE DATE <br /> v�°r Exp.�ro IrtVdon Corrtrel and nesry,cr,n c - INVOICE NUMBER <br /> t <br /> r moans,iawli s, CUSTO R NUMBER 0p 3�p�7t <br /> o <br /> w <br /> GAMBRO HEALTH CARE FOR CUB-FO tWR SeitVICE � PREVIOUS BALANCE Ttt187 <br /> LAURA S)MPSUN eas-STRi•KWAycALt TOTAL ADJUSTMENTS $584 <br /> 152153 BAKE PA 8-2502 6&&783.7422 � TOTAL NEW CHANCES $0.1 <br /> IRVINE. CA 82!318-25Q7 $bog,c <br /> FOR 0- IED-W R ttv5bRt►la rtc�N ( TOTAL AMOUNT DUE <br /> SDt3 Mt D-WASTE ( BY 12f3412004 -� <br /> WLIGHMAS-fFRCCI fiFiCA 80"30��278 _ $1,259.5' <br /> TE: This i510 �'�- <br /> m on this certikaw and °a at the foliowi - <br /> whf is a rano®+tined aUthpgyty ", aeeoribed nomntodity vms Weighed, U742 1 E81 TUSB3000t340 + -i; <br /> Geiifornie F3usinesa aril Profens' aorta acy,as prescribed b C eied,ar rourttecr b e <br /> ions CO*.Codeadministered Y 7 tivmrnerici Y weiBhm®"ter.WI-0 signsture <br /> by the C�iaronrof asureme ng with Section 12700)of Division S ofthe <br /> fli 3tffnd®r1(s of the Cetitwnia Department of Food and&o itfl,(re. <br /> DEC I s 2v <br /> CERTIFICATION,'The )m&teriai listed on the malNtest#s de <br /> r nO",y i30v ntnB the tCe tmesnt of such+nsste.A co ) fits bekrw(infectitxrs modical vvestehes been tra@ted in accordance v�fh the <br /> aaAFSF PY or this certit4cata,aptshcabte nonif, ta. <br /> DATE EST/ QUANTITY/ andappropriate logs witf re -4kowements of re.,deral,Stet®.and foo® <br /> Ct�DtiR'MWEER CONTAINErtiS "l with ttm Company, <br /> pant <br /> PREVIOUS BALANCE ^� WEIGHT <br /> ADJUST NTS -T PRICE TOTAL <br /> NEW CHARGE'S ' $589. 64 <br /> 3fre otl2: t�trmbvy FleiiPfls Cd $0.00 <br /> �aan7[rd ,,*. ,,,SOS <br /> MOM St,1°stfent S <br /> ®dIc al Wants;W"gihsct sf Srorfcyole lno.,<Y38 tA%S Meritsw; A tr 396 3Y08 ' <br /> 11/[)T1200a@ MDFRo01vF7 WftAw,Pees $669.95 <br /> 11fOIrZO04 1.00 Record Ret63722 lad/St6! <br /> MOI`R001 bF 7 enbOn Fee •0sio01y 1"brefghtmps[gr <br /> 11/C4/2.004 MDFR00iW2,j 3-00 <br /> 44 GOP Tub(8ie),C7'12.7 lb 0.00 I,5 <br /> iIMQ2004 2.01) S5.Oso EA <br /> MOFR001 W2 t Rte¢"Re$erittt3iT f ge 14R.70 I t3 $5.25 <br /> ii/Q4JLO(jtl 1.On SO.670 LEI <br /> MOFR001W23 M"muntP&k-up Fee 0.00 LB $65.89 <br /> 11/08/2004 1.00 44 GaI T ) 5,250 EA <br /> f�Ff�p(J1Wl=2 {Bio,CT 12.71b O.Oo 1,8 $38.300 EA55.25 <br /> 1 1 10812 0 04 MDFF�1w 1.00 RO-dRetention Fee 60.90 LB $38.'o <br /> 1 1/1 1170043.0044 3.00 $0.470 L8 $28.62 <br /> MDFRD01 WRR 44(3af TWOio),CT 12.7 Ib 0.00 L8 <br /> 'f 1/1111004 1,00 $5.250 LA <br /> MDFR001 WRR Record Rftition Fee 158.21) LH $0.4 70 L8 $5.25 <br /> 19/11/2pOvt MDFFl0ojWRR 1.00 Mnif"UMPick-uPFee 0.00 LB S78.35 <br /> 1111512004 $5.250 FA <br /> MOF1t001X7Q 2.00 4+C Cael TW®b),CT 12,7fb 0.00 L9 $31.z90 ERSs-25 <br /> 11/15/2004 MOFR00'iX7® 1 0 p Record Reter>tioty Fee 75.80 Z48 $31.29 <br /> 1.00 $0.470 LA <br /> NktkrtTeun l=5ck-up Fee 0.00 LA3 $35.63 <br /> $5.250EA <br /> PLEASECDETA 9.00 L9 $5.25 <br /> CH AND RETUfiN>3t1TTONf $13.930 EA Pt7g71pP' $13.43 <br /> �YOUR PAYMENT IN THE ENCLOSEb ENVELOPE <br />