|
18:28 JUN 07, 2005 TEL NO: 8180 466171 PAGE: 1/2
<br /> Stericycle, Inc. PAGE: 1 of 2
<br /> 13975 Polo Trail Dr, Suite 201
<br /> Lake Forest, IL 60045 INVOICE DATE 71/31!0 r
<br /> INVOICE NUMBER 0C 33124122
<br /> CUSTOMER NUMBER' SG i e 10
<br /> Experts in Infection CwWal and Healthcare Compliance Services
<br /> PREVIOUS BALANCE ss�o.s1
<br /> FOR CUSTOMER SERVICE TOTAL ADJUSTMENTS
<br /> GAMBRO HEALTH CARE 866-STERI-CALL TOTAL NEW CHARGES S7-,2 79
<br /> LAURA SIMPSON 566-783-7422
<br /> 15253 BAKE PARKWAY
<br /> IRVINE,CA 92618-2502 MilloilliFOR PICK-UP INFORMATION TOTAL AMOUNT DUE
<br /> ow 800-MED-WASTE BY 03/0212005 ,'l,`t 43 40
<br /> 800-633-9278
<br /> 31111-U742`1 G20 PM XEQ003207
<br /> W EIGHMASTER CERTIFICATE: This is to certify that the following described commodity was weighed,measured,or counted by a weighmaster,whose signature
<br /> is on this certificale,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 /> YOUR ACCOUNT REFLECTS A BALANCE 30 DAYS PAST DUE
<br /> Commodity Medical Waste;Weighed at Stericycle, Inc.,4135 W Swift Ave, Fresno,CA 93722. Tom Stalberger,Deputy Weightmaster
<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 /> regulators governing the treatment of such waste.A copy of this certificate,applicable manifests,and the appropriate logs will rernain on file with the company.
<br /> MANIFEST/ RUANTITYI
<br /> DATE ORDER NUMBER CONTAINERS DESCRIPTION WEIGHT PRICE TOTAL
<br /> PREVIOUS BALANCE $584.63
<br /> ADJUSTMENTS $0.00
<br /> NEW CHARGES $762.79
<br /> Site 002 Gambro Neagh Care, 1156 S Main St,Patient Services,Manteca,CA 95336.3108
<br /> Commodity Medical Waste;Weighed at Stericycle,Inc.,4135 W Swift Ave,Fresno,CA 93722. Tom Stalberger,Deputy Weightmaster
<br /> 12/30,2004 MDFR0022MF i.'t Record Retention Fee 0.60 L8 ;5.250 EA $5.25
<br /> 12130120(]4 MDFR0022MF 2.o1-1 44 Gal Tub(Bio),CT 12.7 Ib is3._c Ls To.4"r LR $74.°,5
<br /> 01/03'2005 MDFR0022XR 1.oa Record Retention Fee n.G6 LE $S.zSr EA $-.2S
<br /> (]110312005 MDFR0022XR 1Minimum Pick-up Fee LL, ;,_4.63.0 EA $34.5
<br /> 01/131312005 MDFR0022XR _.__ 44 Gal TublBio),CT 12.7 lb 50.70 LE $0.470 Ls $32.29
<br /> 01106,20(5 ti9DFR0023FH i 0 Record Retention Fee o.00 Ls $5.2Su EA
<br /> 01/06120 0 5 NlDFR0023FH 1.C0 Minimum Pick-up Fee o.on Ls EA $16.07
<br /> 01/0812005 MDFR0023FH j.044Gal Tub(Bio),CT 12.7 lb 10e.2n LE $0.470 La $50.85
<br /> 01/10,2005 MDFR00230S 1.00 Record Retention Fee G.G3 LF $5.2�.n EA $5.25
<br /> 0 111 01:200S MDFR00230S i.00 Minimum Pick-upFee n."o LR 1`t25.1an EA $2e.1_
<br /> 0 1 11 01 200 5 MDFR00230S 00 44 Gal Tub{Bio),CT 12.7 Ib d6.80 LE $0.476 LS $40.80
<br /> 01/1322005 MDFR002494 1.00 Record Retention Fee n.,;n LE $5.250 E $5•.25
<br /> PLEASE DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE
<br /> AMOUNT ENCLOSED TOTAL AMOUNT DUE BY 031021'2005
<br /> 51,313.10
<br /> •*! CUSTOMER NUMBER INVOICE DATE INVOICE NUMBER
<br /> 6G1810u 1331/2005 _-063121122
<br /> •�� Stericycle# RE:I:CARD USING For;PAYMEW
<br /> Stericycle, Inc. '^�"
<br /> EC IR TY
<br /> 13975 Polo Trail Dr, Suite 201 ❑MA;TERo4.RD❑DiscoVER LJwisn nreEa,cnr.,Exe "OL1�
<br /> Lake Forest, IL 60045 cnRDNLNEIER E:«DATE
<br /> RETURN SERVICE REQUESTED SIGNATURE �FRINTEDNAME
<br /> 0006018100 0003124122 0000076279 3 030008
<br /> ADDRESSEE: REMIT TO:
<br /> "I1111111II II BI II II"11 111'1'1'1'1"AI Io II it ll ll111111111111 I loll loll 11111 111 "II 111 loll loll 1111 loll 1111111
<br /> GAMBRO HEALTH CARE STERICYCLE, INC.
<br /> LAURA SIMPSON P.O. BOX 79145
<br /> 15253 BAKE PARKWAY
<br /> IRVINE,CA 92618-2502 PHOENIX, AZ 85062-9145
<br /> 111111IIIIIIIIIIIIIIIIIIIIII!Ili IIII111i HlilliIIIIIIill 111111
<br /> 31111-U742'1G241'MXF0003207 1G24PRVL934 Ili 11111111111111 Hill 11111
<br />
|