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® ricycle, Inc. PAG .:,1 of <br /> 00 $t@t'IC CI@ o 75 Polo Trail Dr, Suite 201ni VOICE DATE 09/01/2004 <br /> 0 *018 e Forest, IL 60045 INVOICE NUMBERLE _ <br /> 002914829 <br /> o <br /> d CUSTOMER NUMBER6059477 <br /> Experts in Infection Control and Healthcare Compliance Services INVOICE AMOUNTnJ <br /> oBY 10/01/2004 .00 <br /> FOR CUSTOMER SERVICE <br /> Ln MANTECA CARE&REHAB 866-STERI-CALL CURRENT $924.68 <br /> ACCOUNTS PAYABLE 866-783-7422 1-30 DAYS $836.00 <br /> 0 410 EASTWOOD AVE 31-60 DAYS $0.00 <br /> I- MANTECA,CA 95336-3167 FOR PICK-UP INFORMATION <br /> 0 61-90 DAYS $0.00 <br /> 800-MED-WASTE OVER 90 DAYS $0.00 <br /> 800-633-9278 612610A <br /> 31111-U742*1CBOTD1G2000581 <br /> WEIGHMASTER CERTIFICATE: This is to certify that the following described commodity was weighed,measured,or counted by a weighmaster,whose signature <br /> is on this certificate,and who is a recognized authority of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the <br /> California Business and Professions Code,administered by the Division of Measurement Standards of the California Department of Food and Agriculture. <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 /> 09/01/2004 1.00 Monthly Fuel Charge 0.00 LB $11.000 EA $11.00 <br /> 09/01/2004 1.00 Steri-Safe Standard-Monthly 0.00 LB $825.000 EA $825.00 <br /> 08/30/2004 MDFR001041 2.00 20 Gal Tub(Bio),CT 5.7 LB 0.00 LB $0.000 EA $0.00 <br /> Site 002:SUB TOTAL $836.00 <br /> Site 002:TAX TOTAL $0.00 <br /> FACILITY 1-(ANTIR440r S Fte 002: TOTAL .00 <br /> INVOICE# 000 2 /q&V <br /> GUMONTH P 0 . VOICE AMOUNT-DUE BY 10/01/2004 $836.00 <br /> ACCT# AMOUNT <br /> TOTAL b r <br /> f APPROVAL LEASE DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE <br /> I AMOUNT ENCLOSED INVOICE AMOUNT DUE BY 10/01/2004 <br /> $ $836.00 <br /> CUSTOMER NUMBER DATE INVOICE NUMBER <br /> 0-00 }®p pmV ® F 6059477 09/01/2004 0002914829 <br /> f,�i® Ile/C'�i® CHECK CARD USING FOR PAYMENT <br /> ®® Stericycle, Inc. NSA SECURITY <br /> 13975 Polo Trail Dr, Suite 201 ❑MASTERCARD❑DISCOVER 13 VISA AMERICANEXP. CODE <br /> Lake Forest, IL 60045 CARD NUMBER EXP.DATE <br /> RETURN SERVICE REQUESTED SIGNATURE PRINTED NAME <br /> 0006059477 0002914829 0000083600 3 030004 <br /> ADDRESSEE: REMIT TO: <br /> {Illnlllltnl��ttIIIIIfIIlllltullllllnllltlnllllltnllflll Illll[tlllelltnlll�nlltllellnitllll fill IIIIIIIIIIIIIII IIIII <br /> MANTECA CARE&REHAB STERICYCLE, INC. <br /> ACCOUNTS PAYABLE P.O. BOX 79145 <br /> 10 EASTWOOD AVE <br /> MANTECA,CA 95336"?67 PHOS"'IK AZ 85062-9145 <br /> Illllelelllrelll n Illlell n Illll[Itlltltllltelnlllllleeellellllltl 'npp ��p�gyp' g� <br /> 31111-U74211CBOTD1G2000581 1CBOTHJZO:1.1 11111 lf 1111 Mill If1N11 <br />