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t <br />INVOICE <br />Page No. 1 <br />CALIFORNIA MEDICAL DISPOSAL INVOICE # 103479 <br />P.O. Box 10250, DATE 12/31/04 <br />'FRESNO, CA 93745 <br />1-866-288-2634 <br />SERVICE ADDRESS <br />Memorial,.Hospital Assoc Sutter Tracy Com Hosp Lab <br />P.O. Box 942 1420 N. Tracy Blvd <br />Att Accounts Payable <br />Modesto, CA 95353 Tracy, CA 95376 <br />CUST.# 5508 PO# TERMS Net 30 days <br />------------------------------------------------------------------------ <br />Description TARE WT NET WT/QTY Unit Price Extension <br />-------------------------------------------------------------------------------- <br />PICK UP DATE 12-16-04 <br />MANIFEST #11029 <br />20 GALLON PATHOLOGICAL 7.0 5.9 LBS .650 3.84 <br />20`GALLON'PATHOLOGICAL 7.0 16.9 LBS .650 10.99 <br />44 GALLON RED BAG BIO 15.4 17:4 LBS .205 3.57 <br />44 GALLON RED BAG BIO 15.4 9.8 LBS .205 2.01 <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 />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 />r 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 />ED <br />CEIVE <br />Ate <br />niD���� �i(.VC.3 i.6ttW 4.. µ�U�`✓ <br />-------------------------------------------------------------------------------- <br />WASTE STREAM - IN POUNDS SALES TAX .00 <br />:. -----Chemo -- , 0 _--P-harm _ _ .0 - <br />Pathology 22.8 Sharps .0 TOTAL BILLING 45.41 <br />Red Bag/Bio 27.2 <br />