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PAGE: 1 of 1 <br /> INVOICE DATE //,"'08/31/2004 _I <br /> INVOICE NUMBER 0002905117 <br /> ®_ FACILITY CUSTOMER NUMBER 6059477' <br /> INVOICE# //'7 INVOICE AMOUNT DUE <br /> p GUMONTH 0# BY 09/30/2004 .68 <br /> ACCT# AMOUNT CURRENT $924.68 <br /> _ 1-30 DAYS $0.00 <br /> 31-60 DAYS $0.00 <br /> d 61-90 DAYS $0.00 i <br /> ®_ OVER 90 DAYS $0.00 <br /> TOTAL ,(p S I 31111-U742'1BLOWUKHV000508 261 CA <br /> APPROVALsasured,or counted by a weighmaster,whose signature <br /> ng with Section 12700)of Division 5 of the <br /> -alifornia Department of Food and Agriculture. <br /> jV <br /> CERTIFICATION:The material listed on the manifest#(s)details below(infectious medical waste)has been treated in accordance with the requirements of federal,state,and local <br /> regulations governing the treatment of such waste.A copy of this certificate,applicable manifests,and the appropriate logs will remain on file with the company. <br /> MANIFEST/ QUANTITY/ <br /> DATE ORDER NUMBER CONTAINERS DESCRIPTION WEIGHT PRICE TOTAL <br /> Site 002: Manteca Care&Rehab,410 Eastwood Ave,Manteca,CA 95336-3167 <br /> Commodity Medical Waste,Weighed at Stericycle,Inc.,4135 W Swift Ave,Fresno,CA 93722. Terry Shain,Deputy Weighmaster <br /> 08/02/2004 MDFR001KTC 1.00 20 Gal Tub(Bio),CT 5.7 LB 0.00 LB $0.000 EA $0.00 <br /> 08/09/2004 MDFR001LL6 2.00 44 Gal Tub(Bio),CT 12.7 Ib 39.30 LB $0.000 EA $0.00 <br /> 08/11/2004 B115051 1.00 12 Gal Pharm Sharps-MiniCase 0.00 LB $73.950 EA $73.95 <br /> 08/11/2004 8115051 1.00 Prod SISCtrShlpping&Handling 0.00 LB $9.000 EA $9.00 <br /> 08/16/2004 MDFR001MF4 1.00 44 Gal Tub(Bio),CT 12.7 lb 6.90 LB $0.000 EA $0.00 <br /> 08/23/2004 MDFRO01NAZ 1.00 44 Gal Tub(Bio),CT 12.7 Ib 22.40 LB $0.000 EA $0.00 <br /> Site 002:SUB TOTAL $82.95 <br /> Site 002:TAX TOTAL $5.73 <br /> Site 002: TOTAL $88.68, <br /> INVOICE AMOUNT DUE BY 09/30/2004 $88.58 <br /> PLEASE DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE <br /> AMOUNT ENCLOSED INVOICE AMOUNT DUE BY 09/30/2004 <br /> $ $88.68 <br /> • CUSTOMER NUMBER DATE INVOICE NUMBER <br /> • • 6059477 08/31/2004 i 0002905117 <br /> • Stericycle® <br /> wsA I An^e" CHECK CARD USING FOR PAYMENT <br /> 0 Stericycle, Inc. <br /> FJ�PEEE SECURITY <br /> 13975 Polo Trail Dr, Suite 201 [-]MASTERCARD ❑DISCOVER [I VISA [I AM,FXP CODE <br /> Lake Forest, IL 60045 CARD NUMBER EXP DATE <br /> SIGNATURE PRINTED NAME <br /> RETURN SERVICE REQUESTED <br /> 0006059477 00029051 /7 0000008868 3 030000 <br /> ADDRESSEE: REMIT TO: <br /> lieleniellulleiilieelieueiienellelleelneine0l�lnnl�eei ��nileleleileeelliuleillieineuilelnleieiee�n/illieeeeiii <br /> MANTECA CARE&REHAB STERICYCLE, INC. <br /> ACCOUNTS PAYABLE P.O. BOX 79145 <br /> 410 EASTAVE PHOENIX, AZ 85062-9145 <br /> MANTELATECA,C CA 9 95336-3167 <br /> 31111-u742'1BLOWUKHV000508 18LOX1846:1.1 IIIn1NNIUi11111Ill lull 1111111I NIllRillllllllllllll11111111RillIIIIINII <br />