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18:20 JUN 07, 2005 TEL NO: 8181 #66173 PAGE: 112
<br /> PAGE: 1 of 2
<br /> Stericycle, Inc.
<br /> 13975 Polo Trail Dr, Suite 201
<br /> Lake Forest, IL 60045 INVOICE DATE ti11/fie/��
<br /> INVOICE NUMBER xra1 nom_ !::
<br /> CUSTOMER NUMBER' Sr 1 e 1
<br /> Experts in Infection Cartrol and Healthcare Compliance services
<br /> PREVIOUS BALANCE
<br /> FOR CUSTOMER SERVICE TOTAL ADJUSTMENTS
<br /> GAMBRO HEALTH CARE 855-STERI-CALL TOTAL NEW CHARGES S577.36
<br /> LAURA SIMPSON 855-783-7422
<br /> 15253 BAKE PARKWAY
<br /> IRVINE,CA 92618-2502 FOR PICK-UP INFORMATION TOTAL AMOUNT DUE
<br /> sou-MED-WASTE BY 0313012005 s
<br /> 800-633-9273
<br /> 31111-U742'1 G UOL I G 86003166
<br /> VILIGHMASTER CERTIFICATE: This is to certify that the following described commodity was weighed,measured,or counted by a weighmaster,whose signature
<br /> is on this celtlficale,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 /> Corrrinodity Medical Waste:Weighed at Stericycle, Inc.,4135 W Swift Ave, Fresno,CA 93722. Torn Stalberger,Deputy Weightmaster
<br /> CERTIFICATION:The rraterial rsted on the manifest#(s)details below{infectious medical N,vaste)has been treated in accordance with the requirements of federal,state,and local
<br /> regulations governing the treatment of such waste.A copy of this certificate,applicable manifests,and the appropriate logs will remain on file with the company.
<br /> MANIFEST! QUANTITY,
<br /> DATE ORDER NUMBER CONTAINERS DESCRIPTION WEIGHT PRICE TOTAL
<br /> PREVIOUS BALANCE $1,343.40
<br /> ADJUSTMENTS -$580.61
<br /> 0210822005 Payment -$580.61
<br /> NEW CHARGES $577.36
<br /> Site 002 Gambro Health Care, 1156 S Main St,Patient Services,Manteca,CA 95336-3208
<br /> Commodity Medical Waste;Weighed at Stericycle,Inc.,4135 W Swift Ave,Fresno,CA 93722. Tom Stalberger,Deputy Weightmaster
<br /> 02103'2005 MDFRO0251J 1.I"o Record Retention Fee .oa LE �S.eSri EA $S.25
<br /> 02103!2005 MDFR00251J i.00 Minimum Pick-up Fee o.00 LE t`18.370 EA 18.2.7
<br /> 020312005 MDFR00251J 44 Gal Tub(Bio),CT 12.7 to 10+.30 LE $G.470 LE $4d.5'5
<br /> 02107!2005 MDFROIJ25TX 1 Retention Fee LS $5-250 EA $5.25
<br /> 02107;2005 MDFR0025TX 1.00 Minimum Pick-up Fee o.0Ls yIh.930 EA $35.98
<br /> 0210712005 MDFR0925TX 1.00 44,Sal Tub{Bio),CT 12.7 lb C3.80 Ls $0.4^0 LE :23.99
<br /> 02110;2005 MDFR0027GJ ___�, Record Retention Fee 0.,.1 LE $5.250 EA $S.25
<br /> 0211012005 MDFROo27GJ 1.00 Minimum Pick-up Fee 0.CO LH "14.610 EA $14.61
<br /> 02110x2005 MDFRO027GJ 44 Gal Ti CT 12.7 In 11.1.30 LE $G.4^0 LE $S2.31
<br /> 02114,2005 MDFR0027RA 01 1j Record Retention Fee o.en LE $5.2So EA 55.2.5
<br /> 02114x2005 MDFR0027RA 1 Minimum Pick-up Fee n LE $19.7oi, EA $12.78
<br /> PLEASE DETACH AND P,ETUP.N BOTTOM PORTION WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE
<br /> AMOUNT ENCLOSED TOTAL AMOUNT DUE BY 03/311
<br /> X1,340.15
<br /> CUSTOMER NUMBER INVOICE DATE INVOICE NUMBER
<br /> St@1'ICj/C�t"� 601'100 a2/2a12ao5 0003163561
<br /> CHE-F CARD USING FOR PAY VENT
<br /> Stericycle, Inc. 3ECURITVI
<br /> 13975 Polo Trail Dr, Suite 201 ❑MASTEROA.RD❑DISCOVER vlsA AnaEmcANExe "t'D'-
<br /> Lake Forest, IL 60045 CARD NUA/BER EIF DATE
<br /> RETURN SERVICE REQUESTED 5IGNATURE PRINTEnNAME
<br /> 0006018100 0003163561 0000057736 3 030001
<br /> ADDRESSEE: REMIT TO:
<br /> "1'IBIIII111111loll 1'llloll loll 11'11111Hill lill1IIIIIIII11111 I11111'1l1'IIIIIIII1111111111111Kill'I1I111111 loll 11'11111 loll 11
<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 /> 31111-U742',�uoLl�esoOs,se i U0�N2TN:3.4 IIIIIIillllll���IIIIIIIIIIIII11111IIIIIIIII11111111IN1111131IIIIII 111
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