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e <br />i <br />e <br />f a <br />.a <br />° <br />INVOICE <br />Page No. <br />1 <br />CALIFORNIA MEDICAL DISPOSAL <br />INVOICE # 103781 <br />P.O. Box 10250 <br />DATE 01/31/05 <br />FRESNO, CA 93745 <br />1-866-288-2634 <br />SERVICE ADDRESS <br />Memorial Hosp Assoc <br />Sutter Tracy Dia g <br />Imaging <br />- P.O. Box 942 <br />1530 North Bessie <br />Ave <br />Att: Accounts Payable <br />Suite <br />108-109 <br />Modesto, CA 95353 <br />Tracy, <br />CA 95376 <br />OUST.# 5510 PO# <br />TERMS <br />Net 30 <br />days <br />--------- ----------------------------------------------------------------------- <br />Description TARE WT <br />-- <br />NET WT/QTY <br />Unit -----Price <br />PriceExtension <br />--- --- <br />.,PICK UP DATE 01-06-05 <br />MANIFEST #12382 <br />20 GALLON RED BAG BIO <br />7.0 <br />3.8 <br />LBS <br />.205 <br />.78 <br />PICK UP DATE 01-13-05 <br />MANIFEST #12843 <br />7.0 <br />6.1 <br />LBS25 <br />l <br />b <br />1.25 <br />20 GALLON RED BAG BIO <br />PICK UP DATE 01-27-05 <br />MANIFEST #13748 <br />14.4 <br />LBS <br />.205 <br />2.95 <br />SHARPS <br />.20 GALLON RED BAG BIO <br />.0 <br />7.0 <br />6.0 <br />LBS <br />265 <br />1.23 <br />MINIMUM SERVICE FEE <br />.0 <br />3.0 <br />EACH <br />25.000 <br />75.00 <br />Red Bag/Bio waste less than contract amount <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 FEB 8 <br />Commodity: Medical Waste / Unit of Measure: Pounds <br />jW <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 m <br />governing the treatment of medical waste. A copy of this certificate, `•r `" sEfF, , <br />tracking documents, and treatment logs are on file. The above invoice <br />number serves.as your certifcation of destruction number. <br />F F. B 1 1 2005 <br />'2'Z" <br />----------------- -------------- _------------------------------------------- <br />WASTE STREAM - IN POUNDS SALES TAX .00 <br />Chemo .0 Pharm .0 <br />Pathology .0 Sharps 14.4 TOTAL BILLING 81.21 <br />Red Bag/Bio 15.9 <br />