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til '' ca Care & Rehab <br /> 41 Experts in Infection Control and Healthcare Compliance Services <br /> Accounts Payable <br /> 9188 Glenoaks Blvd,Suite 300 410 Eastwood Ave <br /> Sun Valley CA 91352 Manteca CA 95336-3167 <br /> FOR CUSTOMER FOR PICK-UP INVOICE DATE /INVOICE NUMBER CUSTOMER NUMBER TERMS <br /> SERVICE INFORMATION <br /> CALL 800-953-9324 CALL 800-953-9324 05/01/2004 0002755950 6059477 Net 30 Days <br /> MRNWEST <br /> DATE: QTY t3ESCRIFRON WEIGHT(LB) PRICE U/M 10TAL <br /> NUAABER <br /> Site: 002 Manteca Care & Rehab <br /> 410 Eastwood Ave, Manteca, CA 95336-3167 <br /> WEIGHMASTER CERTIFICATE:This is to certify that the following described commodity was weighed,measured or counted by a weighmaster,whose signature is on this certificate, <br /> who is a recognized authority of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California Business and Professions Code, <br /> administered by the Division of Measurement Standards of the California Department of Food and Agriculture. <br /> Commodity:Medical Waste;Weighed at:Stericycle,Inc.,4135 W Switt Ave,Fresno,CA 93722 Terry Shain Deputy Weighmaster <br /> 04/12/2004 MDFR0017E31.00 44 Gal Tub Bio , CT 12.7 lb 25.90 0.000 EA 0.00 <br /> 05/01/2004 1.00 Steri-Safe Standard-Monthly 0.00 825.000 EA 825.00 <br /> 05/01/2004 1.00 Monthly Fuel Char e 0.00 7.000 EA 7.00 <br /> FACILITY SITE-SUBTOTAL-AMT: $832.00 <br /> INVOICE» 2795910 SITE-TOTAL-TAX: $0.00 <br /> GL.IMONTI-i ®'f SITE-TOTAL-AMT: $832.00 <br /> ACCT--# AMOUNT <br /> TOTAL 32•DO <br /> APPROVAL A <br /> Currmrf1i7;[3ays 3f=6tY Bays �i1 so 134L)ur 9Q Dari§ <br /> 1,657:.hA 1 99 1 1 <br /> U.VV 0.00 INVOICE TOTAL: r832.00 <br /> AtfESSAE:CENTER :: <br /> Due to rising fuel costs, your invoice may reflect a temporary energy charge. <br /> CERTIFICATION: THE MATERIAL LISTED ON THE MANIFEST #'(S) DETAILED ABOVE (INFECTIOUS MEDICAL WASTE) HAS BEEN TREATED IN ACCORDANCE <br /> WITH THE REQUIREMENTS OF FEDERAL, STATE, AND LOCAL REGULATIONS GOVERNING THE TREATMENT OF SUCH WASTE. A COPY OF THIS <br /> CERTIFICATE,APPLICABLE MANIFESTS,AND THE APPROPRIATE LOGS WILL REMAIN ON FILE WITH THE COMPANY. <br /> IBM -TE001 STE00102.RTP 00000727 100000752 DETACH AT PERFORATION AND RETURN BOTTOM PORTION WITH YOUR PAYMENT <br /> --- - <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> ❑ American Express ❑ VISA ❑ MasterCard ❑ Discover <br /> c C (. Credit Card Account Number Expiration Date <br /> e ii ofi W of and Healthcare Compliance Services <br /> Signature <br /> 9188 Gienoaks Blvd,Suite 300 <br /> Sun Valley CA 91352 <br /> 0006059477 0002755950 0000083200 3 030008 <br /> flll�['E'"FAN Please write Amount Paid below <br /> Ilelnelefnef'enllnllenel'neellellnlne'enll"ueel'eel PLEASE STERICYCLE INC <br /> Manteca Care & Rehab SEND PO BOX 79145 <br /> Accounts Payable PAYMENT PHOENIX AZ 85062-9145 <br /> 410 Eastwood Ave TO <br /> Manteca CA 95336-3167 Ilnlnlelelfunflenc�ellele/Al10le�nl®�®1®eln'ele'®enlll <br /> 00000727 40 8505 <br /> 'nvoice Customer Date: Invoice FP. <br /> unt <br /> ',lumber: 0002755950 Number: 6059477 05/01/2004 amount: $832.00 <br /> $ <br />