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cowl <br />INVOICE <br />CALIFORNIA MEDICAL DISPOSAL <br />P.O. Box 10250 <br />FRESNO, CA 93745 <br />1-866-288-2634 <br />MEMORIAL-HOSP ASSOCIATION <br />ATTN:ACCTS PAYABLE <br />P.O. BOX 942 <br />MODESTO, CA 95353 <br />C7 <br />Page No. 1 <br />INVOICE # 103235 <br />DATE 11/30/04 <br />SERVICE ADDRESS <br />Sutter Tracy Hospital <br />1420 N. Tracy Blvd. <br />Tracy, CA 95376 <br />CUST.# 5234 PO# <br />TERMS <br />Net 30 <br />days <br />------------------------------------ <br />Description <br />TARE WT <br />NET WT/QTY <br />Unit <br />Price <br />Extension <br />PICK UP DATE 11-04-04 <br />MANIFEST #8738 <br />S14 SHARPSMART PHARM <br />.0 <br />15.0 <br />CNT <br />.000 <br />.00 <br />S32 SHARPSMART PHARM <br />.0 <br />6.0 <br />CNT <br />.000 <br />.00 <br />SHARPSMART PHARM PROCESS <br />16.2 <br />112.0 <br />LBS <br />1.250 <br />140.00 <br />WEIGH MASTER CERTIFICATE <br />.0 <br />1.0 <br />EACH <br />.000 <br />.00 <br />This is to cerify that the following described commodity was weighed, <br />measured, or counted by a weighmaster, whose signature is on this <br />certificate, who is a recognized authority of accuracy, as prescribed by <br />Chapter 7 (commencing with Section 12700) of Division 5 of the California <br />Business and Professions Code, administered by the Division of Measurement <br />Standards of the California Department of Food and Agriculture. Principle <br />Weigh Master: Central Valley Medical Disposal / Deputy Weigh Master: Walter <br />Brumley, Jr. Address: 4100 E Therese, Fresno, CA 93725 <br />Commodity: Medical Waste / Unit of Measure: Pounds <br />DOCUMENT OF DESTRUCTION .0 1.0 EACH .000 .00 <br />This is to certify that the above described medical waste was treated in <br />accordance with the requirements of Federal, State and Local regulations <br />governing the treatment of medical waste. A copy of this certificate, <br />tracking documents, and treatment logs are on file. The above invoice <br />number serves as your certifcation of destruction number. <br />DFC. 20C4 <br />0 CIA <br />1 <br />----------------------------------------------------------------------- <br />i <br />_--- _ __VASTE--STREAM - IN POUNDS ._ _SALES- TAX I_ ..00 <br />Chemo .0 Pharm 112.0 <br />Pathology .0 Sharps .0 TOTAL BILLING 140.00 <br />Red Bag/Bio .0 <br />