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INVOICE <br />CALIFORNIA MEDICAL DISPOSAL <br />P.O. Box 10250 <br />FRESNO, CA 93745 <br />1-866-288-2634 <br />Page No. 1 <br />INVOICE # 103481 <br />DATE 12/31/04 <br />" SERVICE ADDRESS <br />Memorial'Hosp Assoc Sutter Tracy Diag Imaging <br />P.O. Box 942 1530 North Bessie Ave <br />Att: Accounts Payable Suite 108-109 <br />Modesto, CA 95353 Tracy, CA 95376 <br />CUST.# 5510 PO# TERMS Net 30 days <br />------------------------------------------ <br />Description TARE WT NET WT/QTY Unit Price Extension <br />-------------------------------------------------------------------------------- <br />PICK UP DATE 1.2-09-04 <br />MANIFEST #10554 <br />20 GALLON RED BAG BIO 7.0 8.0 LBS .205 1.64 <br />20 GALLON RED BAG BIO 7.0 8.1 LBS .205 1.66 <br />20 GALLON RED BAG BIO 7.0 7.2 LBS .205 1.48 <br />MINIMUM SERVICE FEE .0 1.0 EACH 25.000 25.00 <br />Red Bag/Bio waste less than contract amount <br />PICK UP DATE 12-16-04 <br />MANIFEST #11031 <br />20 GALLON RED BAG BIO 7.0 4.7 LBS .205 .96 <br />MINIMUM SERVICE FEE .0 1.0 EACH 25.000 25.00 <br />Red Bag/Bio waste less than contract 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 />rIECEIVEri <br />Standards of the California Department of Food and Agriculture. Principle <br />Weigh Master: Central Valley Medical Disposal / Deputy Weigh Master: Walter JAN ,4 <br />Brumley, Jr. Address: 4100 E Therese, Fresno, CA 93725 <br />Commodity: Medical Waste / Unit of Measurer 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, - psc <br />tracking documents, and treatment logs are on file. The above invoice A® G® lC7iq <br />number serves as your certifcation of destruction number. DE <br />------------------------------------------------------ <br />0 <br />WASTE STREAM IN POUNDS SALES TAX .0 <br />Chemo .-0 _-Pharm_ __. 0 - <br />Pathology .0 Sharps .0 TOTAL BILLING 87.57 <br />Red Bag/Bio 61.4 /� <br />