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CALIFORNIA MEDICAL DISPOSAL <br />P.O. Box 10250 <br />FRESNO, CA 93745 <br />1-866-288-2634 <br />INVOICE <br />E <br />Page No. 1 <br />INVOICE # 104096 <br />DATE 02/28/05 <br />, <br />SERVICE ADDRESS <br />,.,Memorial -Hospital Assoc 2 Sutter Tracy Com Hosp Lab <br />P.'O. Box. 942 1420 N. Tracy Blvd ' <br />Att: Accounts Payable Accounts <br />Modesto, CA 95353Gx�, Tracy, CA 95376 <br />OUST.#. 5508 PO# TERMS Net 30 days <br />---------------------------- e <br />- <br />Description TARE WT NET WT/QTY Unit Price Extension <br />.PICK UP. DATE 02-17-05 <br />MANIFEST 415171 <br />44 GALLON RED BAG,BIO 15.4 15.7 LBS .205 3.22 <br />44 GALLON RED BAG BIO 15.4 18.9 LBS .205 3.87 <br />20 GALLON PATHOLOGICAL 7.0 100.5 LBS.6 0 6.83 <br />20 GALLON PATHOLOGICAL 7.0 13.1 LBS .6 0 8.52 <br />MINIMUM SERVICE FEE .0 1.0 EACH 25.0 0 25.00 <br />Red-Bag/Bio waste less than contract amount <br />WEIGH MASTER CERTIFICATE .0 1.0 EACH .060 .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 adcuracy, 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 />------ ------------------------------------------------------------------- <br />WASTE STREAM.- IN POUNDS SALES TAX .00 <br />Chemo .0 Pharm .0 <br />Pathology 23.6 Sharps .0 TOTAL BILLING 47.44 <br />Red Bag/Bio 34.6 <br />