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Y <br />, <br />INVOICE <br />Page No. <br />1 <br />CALIFORNIA MEDICAL DISPOSAL <br />INVOICE # 103481 <br />P.O. Box 10250 <br />DATE 12/31/04 <br />FRESNO, CA 93745 <br />1-866-288-2634 <br />" <br />SERVICE <br />ADDRESS <br />Memorial-Hosp Assoc <br />Sutter <br />Tracy Diag <br />Imaging <br />P.O. Box 942 <br />1530 North <br />Bessie <br />Ave <br />Att: Accounts Payable <br />Suite <br />108-109 <br />Modesto, CA 95353 <br />Tracy, <br />CA 95376 <br />CUST.# 5510 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 />-------------------------------------------------------------------------------- <br />PICK UP DATE 1.2-09-04 <br />MANIFEST #10554 <br />20 GALLON RED BAG BIO <br />7.0 <br />8.0 <br />LBS <br />.205 <br />1.64 <br />20 GALLON RED BAG BIO <br />7.0 <br />8.1 <br />LBS <br />.205 <br />1.66 <br />20 GALLON RED BAG BIO <br />7.0 <br />7.2 <br />LBS <br />.205 <br />1.48 <br />MINIMUM SERVICE FEE <br />.0 <br />1.0 <br />EACH <br />25.000 <br />25.00- <br />5.00Red <br />RedBag/Bio waste less than <br />contract <br />amount <br />PICK UP DATE 12-16-04 <br />MANIFEST #11031 <br />20 GALLON RED BAG BIO <br />7.0 <br />4.7 <br />LBS <br />.205 <br />.96 <br />MINIMUM SERVICE FEE <br />.0 <br />1.0 <br />EACH <br />25.000 <br />.25.00 <br />Red Bag/Bio waste less than <br />contract <br />amount <br />PICK UP DATE 12-30-04 <br />MANIFEST #11938 <br />20 GALLON RED BAG BIO 7.0 16.6 LBS .205 3.39 <br />20 GALLON RED BAG BIO 7.0 16.8 LBS .205 3.44 <br />MINIMUM SERVICE FEE .0 1.0 EACH 25.000 25.00 <br />Red Bag/Bio waste less than contract amount <br />WEIGH MASTER CERTIFICATE .0 1.0 EACH .000 .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 />RECEIVED <br />Standards of the California Department of Food and Agriculture. Principle <br />Weigh Master: Central Valley Medical Disposal / Deputy Weigh Master: Walter JAN <br />.� <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 .0 <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, pt.asEsiG ,. <br />tracking documents, and treatment logs are on file. The above invoice': <br />number serves as your certifcation of destruction number. AND CODE <br />---------------------------------------------------- <br />WASTE STREAM IN POUNDS SALES TAX .00 <br />Chemo _ _ .0- _ Pharm - _. ®- <br />Pathology .0 Sharps .0 TOTAL BILLING 87.57 <br />Red Bag/Bio 61.4 �'� <br />