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t <br />P <br />• <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 />INVOICE <br />Page No. 1 <br />INVOICE # 103570 <br />DATE 12/31/04 <br />SERVICE ADDRESS <br />Sutter Tracy Hospital <br />1420 N. Tracy Blvd. <br />Tracy, CA 95376 <br />CUST.# 5234 PO# TERMS Net 30 days <br />-------------------------------------------------------------------------------- <br />Description TARE WT NET WT/QTY Unit Price Extension <br />---------------------------------------------------------------------------- <br />PICK UP DATE 12-02-04 <br />MANIFEST #10047 <br />-S14 SHARPSMART PHARM .0 16.0 CNT .000 .00 - <br />S32 SHARPSMART PHARM .0 17.0 CNT .000 .00 <br />SHARPSMART PHARM PROCESS 16.2 263'.0 LBS 1.290 328.75 <br />WEIGH MASTER CERTIFICATE. .0 1.0 EACH .0d0 .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. SE <br />_ <br />AND CODF <br />6 A <br />RE <br />CEIVEr) <br />�-- JA" 2 7 2005 <br />ACCouAfTS <br />PAY <br />ABLE <br />------------------------------------------- <br />WASTE STREAM - IN POUNDS SALES TAX .00 <br />---- chemo ---- ,0 -- - Pharm- ----2-63.0--..- -- _ -- _ - -- _ <br />Pathology .0 Sharps .0 TOTAL BILLING 328.75 <br />Red Bag/Bio .0 <br />