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>ent by: GAMBRO 9498315035; 0611112005 4:35AM; #686; Page 7/24 <br /> • <br /> ru Aim <br /> Steric Of$, Inc, <br /> w Steric cle 1397YPolo TraitCUr, €,ite 201 RAGE: i of <br /> Lake Forest, IL 60045 —�___._— <br /> rr INVOICE DATE <br /> Fx a to is Eeetm4g}�Cantrnt end"wetthcare Co <br /> 9 <br /> a mPtto*aes INVOICE NUMBERsarvtcss CUSTOMER tF1U <br /> MBER <br /> 601810 <br /> w <br /> "`c GAMBRO HEALTH CARE FORCUs;T7MEttSVRV1C PREVIOUS BALANCE <br /> LAURA SfMPSpN TOTAL ADJUSTMENTS <br /> Ct 1525a SAKE PARKWAY 8�8-::tFRt.CALt -$1 25 c <br /> u <br /> IRVINE. K 4PARK 502 783-7422 TOTAL NEW CHARGES <br /> POR tcwr-uR INFORMATION TOTAL r4i�t0 ' 7- <br /> UE <br /> 800-613- 278 <br /> 800-MED-WA$TF a, 61/30/2005 <br /> WE{Gi1MAS CLF2l"tFIGAl"E $580.$1 <br /> is on This cerTirFcale tend This is W ri+{4ify ttwst Uie foitawing t9esctibad cc3nzmoc4iYy was van 31 T 1 1 11747 1 F•9 7 7.K 5P, <br /> WtlO is nrecCW14ftd authprky of accurac as ~� S(YQ3271 f1251f <br /> California Ousinees and I ro Y. 6xescri fid,meas-ed,w Counted by a weighmaetei,wi�oar ai4{naiure <br /> tassions Code,adroirngEerepi by lt7S D{YiaiOn of M> h Bacton 12700,af !vision S of The <br /> iia I" od and Agriculture. <br /> EWER DA L <br /> CERTIFICATION:T{g' a <br /> regulations ov ateriat listed on the men{feat a s <br /> g errfir g the treatment of such wast®.A co mi tts (Infectious medicat waste <br /> _ Py 0f this certiftate,a has been treateCt in accttrdancr^with the requiranfents of f�derat athte.and f0rat <br /> DA TF MANtFEsTr �a rrifests,aart7 the eofxfate fo s will re <br /> ORDBR NUMBER C 4tTE-11IYt g nutin on file with the cornpan <br /> +JN'1'AlN6iRt3 DESCRIPTIOty ..._..�'_,`-^ <br /> PREVIOUS BALANCE <br /> avcrohr PRICE <br /> ADJU3 Nig <br /> 12!03!2004 <br /> 01104/2006 Ps"nt <br /> P®Y"nt <br /> N <br /> CHARGES -5669.95 <br /> ,alto 002: 64mb-Hea th Cara, 4766 3 Mein 3t,P`tlottt$ <br /> C*mmut(ftY feWool We,,*, eWfco.,A/snleoa,CII 8115 -3 <br /> 121412!7004 WWSPhed at 3tarlcyola,Ina,4136 wrsyyfR.ave,i�rvano. $580.61 <br /> M0FP0olzus sarzx rcnrsr.t <br /> 72J0212(44 1 np Rid R"tention Feg "voP Deputy w►om'4a4ar <br /> Mi7FF20017_t7S <br /> 1-?02 2004 1.0o Minimum Pick-up Fee 0.00 Ltd <br /> MDFR0012D5 <br /> 1,'x/0672004 M0FRo01Zpg 2.00 44 Gal Tub00),C'f 12.7 rb 0.00 L8 55.250 T'J1 $5.25 <br /> .°.7.1pA72004 i.00 R—'Ord Retention Fee 322.80 1,B $9.200 FAS9,20 <br /> MOFR0012P6 $0.470 LB <br /> 12 08120(yr 1 M0FR001Zp6 .0 0 Minirnurn P{ck-up Fee 0-00 LB s5.250 $57-7 a <br /> EA <br /> = J09/20(y4 Mt:3FR0020d8 2 00 44 Gat Tub(Bio),CT 12.7 R' 0.0o la $3-'$-640 EA $5.2 <br /> 5 <br /> i 2/0E3/24u}q 11,00 Recd Retsil0o t Fee 70.80 LB <br /> Mt7FF100208t3 $0,470 L8 $31-64 <br /> 2!014120(M MQFf7002066 1.00 14 WntlmPick-up Fee 0.00 LB $33.28 <br /> 5S-250 EA <br /> 2113/2004 MDFR d.00 44 GaITUh(8to),CT t2,7'lb 0.00 LEi $16,020 F..R $5 2S <br /> 0021]fJ(3 1,00R-ordReterrdOnFee 108.30 LB $0.470 L13 $16.02 <br /> PLtA$E DETACH AND RETURN SE7TTOM0.00 7,5 r $150.90 <br /> PORTION WITH YOUR PAYMENT IN TNF $S.2 <br /> ENCLOSED ENVELOPE <br />