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i <br />PAST DUE <br />PLEASE IT <br />PAYMENT INVOICE , <br />e <br />Page No. 1 <br />CALIFORNIA MEDICAL DISPOSAL INVOICE # 103023 <br />P.O. Box 10250 , DATE 10/30/04 e <br />FRESNO, CA 93745 <br />1-866-288-2634 EID <br />Rice" <br />SERVICE ADDRESS <br />MEMORIAL HOSP ASSOCIATION �pR 2 �' 2005 Sutter Tracy Hospital <br />ATTN:ACCTS PAYABLE 1420 N. Tracy Blvd. <br />P.O. BOX 942 (3aya�18 <br />MODESTO, CA 95353pcC01111tS Tracy, CA 95376 <br />e e <br />CUST.#. 5234 '.PO# , TERMS NET 10 DAYS'. , <br />-------------------------1--------------- <br />Description TARE WT NET WT/QTY Unit Price Extension <br />-------------- -'----------- <br />- <br />- --- - - - - - -- -- ---- - - -- l --------------------------------------- <br />--- <br />1 <br />PICK UP DATE 10-07-04 <br />MANIFEST #7785 <br />S14 SHARPSMART PHARM .0 2.0 CNT .000 .00 ' <br />S32 SHARPSMART PHARM .0 11.0 CNT .000 .00 <br />SHARPSMART PHARM PROCESS 1.6.2 ' 113.1 LBS 1.250 141.38 <br />PICK UP DATE 10-13-04 <br />MANIFEST #7982 <br />S14 SHARP$MART PHARM .0 2.0 CNT .000 .00 ' <br />S32 SHARPSMART PHARM .0 3.0 CNT .000 .00 <br />SHARPSMART PHARM PROCESS 16.2 40.0 LBS 1.250 50.00 . <br />WEIGH MASTER CERTIFICATE .0 1.0 EACH .000 .00 <br />This is to cerify that the following described commodity was weighed, <br />neasured, 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 />i4eigh Master: Central Valley Medical Disposal / Deputy Weigh Master: Walter <br />Brumley, Jr. Address: .41.00 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 />PLE S'E AGN <br />Via' cry AND CODE <br />------------------ ------------------------------------------------------------- <br />WASTE STREAM - IN POUNDS SALES TAX .00 <br />Chemo .0 Pharm 153.1 <br />Pathology .0 Sharps .0 TOTAL BILLING 191.38 <br />Red Bag/Bio •0 <br />