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1 <br />INVOICE <br />REC"; ° a ,, Page No. 1 <br />CALIFORNIA MEDICAL DISPOSAL INVOICE # 104093 <br />P.O. Box 10250MAR 2 <br />DATE 02/28/05 e <br />FRESNO, CA 93745 2(jr <br />1-866-288-2634 <br />ACGOIli1fS NB+ . ICE ADDRESS <br />MEMORIAL HOSP ASSOCIATION Sutter Tracy Hospital <br />ATTN:ACCTS PAYABLE 1420 N. Tracy Blvd. <br />P.O. BOX 942 <br />MODESTO, CA 95353 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 02-03-05 <br />MANIFEST #14201 <br />S14 SHARPSMART PHARM .0 20.0 CNT .000 .00 <br />S32 SHARPSMART PHARM .0 19.0 CNT .000 .00 <br />SHARPSMART PHARM PROCESS 16.2 330.5 LBS 1.250 413.13 <br />PICK UP DATE 02-10-05 <br />MANIFEST #14674 <br />20 GALLON CHEMO 7.0 5.9 LBS .650 3.84 <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 />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 />AND COLIC <br />e. <br />--------------------------------------------------- <br />WASTE STREAM - IN POUNDS SALES TAX .00 <br />Chemo 5.9 Pharm 330.5 <br />Pathology .0 Sharps .0 TOTAL BILLING 441.97 <br />Red Bag/Bio .0 <br />M <br />