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• PAGE: 1 of 2 <br /> 'cycle, Inc. --- — _ - --- <br /> %N v tP1 J �,4 5 Polo Trail Dr, Suite 201 <br /> Lake Forest, IL 60045 VOICE DATE / 05/01/200 <br /> w INVOICE NUMBER 0003221462 <br /> D. CUSTOMER NUMBER 6059477 <br /> Experts in Infection Control and Healthcare Compliance Services <br /> o PREVIOUS BALANCE $1,974.00 <br /> FOR CUSTOMER SERVICE TOTAL ADJUSTMENTS -$1,974.00 <br /> Lri <br /> MANTECA CARE&REHAB 866-STERI-CALL TOTAL NEW CHARGES $989.50 <br /> C:3 ACCOUNTS PAYABLE 866-783-7422 <br /> 410 EASTWOOD AVE <br /> p MANTECA, CA 95336-3167 FOR PICK-UP INFORMATION TOTAL BALANCE DUE <br /> ru no 800-MED-WASTE BY 05/31/2005 $989.50 <br /> 800-633-9278 ! ___ .._._..-. ___ __ _- <br /> 31111-U742 <br /> --31111-U742*1 I1)01`186W SO <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 /> PREVIOUS BALANCE $1, 974.00 <br /> ADJUSTMENTS -$1,974.00 <br /> 04/01/2005 Payment -$984.50 <br /> 04/25/2005 Payment -$989.50 <br /> INCE $0.00 <br /> $989.50 <br /> N berger,Deputy Weightmaster <br /> FACILITY 0.00 LB $16.000 FA $16.00 <br /> INVOICE# �2- 0.00 LB $973.500 EA $973.50 <br /> GL,IMONTH 0.00 LB $0.000 EA $0.00 <br /> ACCT# AMOUNT 24.10 LB $0.000 EA 50.00 <br /> Zo s 0.00 LB $0.000 EA $0.00 <br /> 7.60 LB $0.000 EA $0.00 <br /> 22.60 LB $0.000 EA $0.00 <br /> $989.50 <br /> TOTAL $0.00 <br /> APPROVAL $989.50 <br /> I PORTION WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE <br /> ENCLOSED TOTAL BALANCE DUE BY 05/31/2005 <br /> $989.50 <br /> ® CUSTOMER NUMBER INVOICE DATE INVOICE NUMBER <br /> 00 C} p Q 6059477 05/01/2005 0003221462 <br /> 169- V\e 1 I/�V y c l ee ICHECK CARD USING FOR PAYMENT <br /> Stericycle, Inc. NSA SECURITY <br /> ® 13975 Polo Trail Dr, Suite 201 ❑MASTERCARD❑DISCOVER ❑VISA ❑AMERICANEXP CODE <br /> Lake Forest, IL 60045 CARD NUMBER EXP DATE <br /> RETURN SERVICE REQUESTED SIGNATURE PRINTED NAME <br /> 0006059477 0003221462 0000098950 3 030001 <br /> ADDRESSEE: REMIT TO: <br /> Illlollllllllllll�ll�lll�lllll�IIIII111sill�llllllllllllllllll IIIeIlIIILIII�lllllillllllllllllllilll�lllllllllllllllllt�lll <br /> MANTECA CARE&REHAB STERICYCLE, INC. <br /> ACCOUNTS PAYABLE P.O. BOX 79145 <br /> 410 EASTWOOD AVE PHOENIX, AZ 85062-9145 <br /> MANTECA, CA 95336-3167 <br /> Illllntllleelllnllllllllrielllllellleaillllelllllllnlelll�llelal <br /> 31111-U742'11DOR86WS005409 11DOREQ61:1.2 11111 lilt <br /> III No 1111IN <br /> 1111111111 ON Ilip III II <br />