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EHD Program Facility Records by Street Name
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4500 - Medical Waste Program
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PR0522691
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COMPLIANCE INFO
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Entry Properties
Last modified
2/23/2023 10:14:33 AM
Creation date
7/3/2020 10:21:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4500 - Medical Waste Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0522691
PE
4530
FACILITY_ID
FA0013665
FACILITY_NAME
DAVITA MANTECA DIALYSIS CENTER
STREET_NUMBER
1156
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
222-380-080-300
CURRENT_STATUS
02
SITE_LOCATION
1156 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\MW\MW_4530_PR0522691_1156 S MAIN_.tif
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EHD - Public
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=ant by: GAMBRO 9498315035; 06/11 /2005 4:35AM; #686; Page 5/24 <br /> r� Steflcycle. Inc. <br /> "' 44 ;e- 1397 Polo Trail Df,Suit>l7201 PAGE; 7 p 1 <br /> l_ek8 Forest, IL 60045 <br /> INVOICE DATE <br /> as IMtfCtICE IVtI11lbER 01/31/20 <br /> Ppb In I�+hcdtfn Conb bl*MCI Harttlsc�arsk <br /> tlbry CUSTOMER N!1 OW31247 <br /> Lu <br /> l`R 60181 <br /> GAM MRO HEALTH CARE FOR CUSTOMER S!_IeVICE PREVIOUS BALANCE <br /> aU1j LAUF2A SIMPSOht eft-STERI-CALL TOTAL ADJUSTMENTS 3580.E <br /> 15253 VIN ,CA PARKWAY 8,2502 s6B 7� -7d TOTAL NEW CHARGES $O.C <br /> IRVINE. CA 926t8.2&oZ 5762.7 <br /> POR PICK-Lip INPOR lA-rioN .TOTAL, <br /> -MELD-WASTE OUNT DUE <br /> Vd'E3.9279 BY 03/02/2005 <br /> IGHMA3TER CERTIFICATE' fhia a to r $1.343.4( <br /> fe on tFafa Certirfcete,entl w cs `that the IbSO Nv dBs Oammod 311 t 1-U742 r 7 G20 <br /> California BUS i$Cat ® p retlognizbd autt-ityOfffiaa c , �Y"a weigh mmesured,or caurreer!b � -xF 1207 <br /> end rot aaionR Code,adminlatersd Yes presce by Cha 7 Oomrnefte y e weighrriaatsr,whaae a <br /> by the Division of 9 with Sect�n 12700 f �&lnatuns <br /> YOUR A a of 3tk )o Division 5 of the <br /> ACCOUNT REFLECTS A BALANCE *f&*Callfarnta Detuartment of Food and Agricultwe. <br /> Commodity iYTedical Wastt3;Weighed at S 30 PAYS PAST DLII <br /> � tericycle,Inc,,4135 1N Swilt Ave,Fresno,CA '95722: Tarn StOiberger, peput <br /> Y t r�yt2 <br /> CERTIFICATION:The r)tatetiet ilatod on the rnjsNIeat#(s)detalta t7ek7w <br /> re9t+lations governing the treatment of Such (infectious <br /> wears,A copy of tag Certificate, Medical wasfa)has been treated in aCCardan0e with re <br /> MANIFEST/ ate;aPF Ica manlfeat&,and the Cuframmnu of federal,state,and focal <br /> DATE ORDER►NUmgEk QIFA CONTAINERS t aPT)"te IOW will remain on frlb with the Corn <br /> GrNdTAlNEiRB CRN'Tnr� Pr+ny. <br /> PREVIOUS$ALANCE WEIGHTADJUSTMENTS PRICE TOTAL <br /> NEW CHARGES $580.61 <br /> �4 <br /> Stta - Oembro Hoeltfi C ro, tt6B s eln $0.00 <br /> Commadity Ii1adlot!lrf/sate;yyt� �Patla'nr 3'tarveyy IWanJ'Ow, 00,1 <br /> a2/0 ®hadetstrioycfs,tnc"436WSwff.�g ,Fresno $762.79 <br /> MI)R0022MF- 93732 Tom StaF <br /> 12./30( 1010 R0022MF 1.00 Rid Retention Fee : -3*W.,fa,&,naatar <br /> 01103f2005 MDFR0022XR 3.00 44 Gal Tub(glo),CT 12.7 ib 0.40 LS <br /> 01!0=10061,00 $5.250 EA <br /> MOFRo022XR Record RetentionP" 558.20 LB $0.470 LB $5.25 <br /> 07/06;rZoos MDFR0022�R 1.00 mntmOt Pickup Fes 0.00 LF3 � $74.3S <br /> $S.as6 <br /> 01t08f(3f65 2 00 44 GO'T;Jb(Sio),CT 12.7 It1 0.00 L$ $5.25 <br /> MDFR0020(:H 3,00 $34.536 &A01/08/2005 MDFR0023FH Ree-dRetentaan'Fee 60.70 LB $34.63 <br /> 0110g(2Q0r� 1.00 $0.470 L$ <br /> h0FR0023FH num Pickup F" 0.00 LB 532.29 <br /> 4;?1/70f�005 3.60 S`+-250 EAMOFR0028Q8 44 Oaf Tub(El0),CT 12,7 rb 0.00 LB $16.070 EA $5.25 <br /> D11tOf200t; Mv1DFRW230S 1.00 Record Rbtantbn F 108,20 LE 816.07 <br /> )9170120% 1.00 $D.47p IB <br /> MOFR0fi2308 �°IylClt..up Fee 0.00 1,B $5.250 )� SS o.85 <br /> ;'d113J200g MDFRo0248.4 2.00 44 Gol TWEli-),CT 12:71b 0.00 LH S5.25 <br /> R <br /> 1.00 - $26.120 EA <br /> ocord Reter�ion Fee 86.90 La526,12 <br /> $0.470 LH <br /> PLEASE DEfACM AND,,, <br /> 0.00 I B $5 $40.80 <br /> TTOM POR 250 EA <br /> TION WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE <br />
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