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r" <br />i <br /><g <br />A F <br />INVOICE <br />CALIFORNIA MEDICAL DISPOSAL <br />P.O. Box 10250 <br />FRESNO, CA 93745 <br />1-866-288-2634 <br />Memorial Hospital. Assoc <br />P.O. Box 942, <br />Att.: Accounts Payable <br />Modesto, CA 95353 <br />fo <br />Page No. 1 <br />INVOICE # 103782 <br />DATE 01/31/05 <br />SERVICE ADDRESS <br />Sutter Tracy Com Hosp Lab <br />1420 N. Tracy Blvd <br />Tracy, CA 95376 <br />CUST.# 5508 PO# <br />EACH <br />TERMS <br />Net 30 <br />days <br />This is to certify that the above described medical <br />------------------------------- <br />Description <br />------------------------------------------------------------------------------ <br />TARE WT <br />NET WT/QTY <br />Unit <br />Price <br />Extension <br />PICK UP DATE 01-06-05 <br />governing the treatment of medical waste. A copy of <br />this <br />certificate, <br />MANIFEST #12380 <br />tracking documents, and treatment logs are on file. <br />The above invoice <br />number serves as your certifcation of destruction number. <br />20 GALLON PATHOLOGICAL <br />7.0 <br />9.7 <br />LBS <br />.650 <br />6.31 <br />20 GALLON PATHOLOGICAL <br />7.0 <br />9.7 <br />LBS <br />.650 <br />6.31 <br />20 GALLON PATHOLOGICAL <br />7.0 <br />14..1 <br />LBS <br />.650 <br />9.17 <br />44 GALLON RED BAG BIO <br />15.4 <br />15.2 <br />LBS <br />.205 <br />3.12 <br />44 GALLON RED BAG BIO <br />15.4 <br />17.3 <br />LBS <br />.205 <br />3.55 <br />PICK UP DATE 01-27-05 <br />.00 <br />Chemo .0 Pharm .0 <br />MANIFEST #13746 <br />Pathology 71.2 Sharps .0 <br />TOTAL <br />BILLING <br />60.33 <br />20 GALLON PATHOLOGICAL <br />7.0 <br />17.9 <br />LBS <br />.650 <br />11.64 <br />20 GALLON PATHOLOGICAL <br />7.0 <br />19.8 <br />LBS <br />.650 <br />12.87 <br />44 GALLON RED BAG BIO <br />15.4 <br />16.7 <br />LBS <br />.205 <br />3.42 <br />44 GALLON RED BAG BIO <br />15.4 <br />19.2 <br />LBS <br />.205 <br />3.94 <br />WEIGH MASTER CERTIFICATE <br />.0 <br />1.0 <br />EACH <br />.000 <br />.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 <br />EACH <br />.000 <br />.00 <br />FEB 18 <br />This is to certify that the above described medical <br />waste <br />was treated in <br />accordance with the requirements of Federal, State <br />and Local regulations <br />governing the treatment of medical waste. A copy of <br />this <br />certificate, <br />tracking documents, and treatment logs are on file. <br />The above invoice <br />number serves as your certifcation of destruction number. <br />f, <br />PLTUiS'�. cSIGN <br />FEB <br />A.`O COOE. <br />T 1 <br />f--------------------------------------------- <br />-I <br />---------------------------- ---- <br />WASTE STREAM - IN POUNDS <br />SALES <br />TAX <br />.00 <br />Chemo .0 Pharm .0 <br />Pathology 71.2 Sharps .0 <br />TOTAL <br />BILLING <br />60.33 <br />Red Bag/Bio 68.4 <br />