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rdye: 1 OT 1 <br /> ' 4 ' <br /> 0 9 ESu . idge Manteca <br /> Experts in Infection Control and Healthcare Compliance Services <br /> r Tabatha <br /> 9188 Glenoaks Blvd,Suite 300 410 Eastwood Ave <br /> Sun Valley CA 91352 �Q �E Manteca CA 95336-3167 <br /> FOR CUSTOMER FOR PICK-UP INVOICE DATEBER CUSTOMER NUMBER TERMS <br /> SERVICE INFORMATION <br /> CALL 800-953-9324 CALL 800-953-9324 01/01/2004 0002572613 6018848 Net 30 Days <br /> DATE MANIFESTQTY DESCRtP N I H7(LB) PRICE:U!M TOTAL:,: <br /> NUMBER <br /> Site: 002 Sunbridge Manteca <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 /> /r <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 Swift Ave,Fresno,CA 93722 Terry Shain Deputy Weighmaster <br /> 12/08 2003 1 MDFROOOS_5B­F 2.00 44 Gal Tub Bio , CT 12.7 lb 53.30 0.000 EA 0.00 <br /> 01/ 1-D�. Steri-Safe Standard-Monthly 0.00 711.940 EA 711.94 <br /> FACILITY - <br /> VEPVDORa SITE-SUBTOTAL-AMT: $711.94 <br /> SITE-TOTAL-TAX: $0.00 <br /> iNVOICEZ SITE-TOTAL-AMT: $711.94 <br /> DEFT ACCT AMWNP <br /> 711. <br /> TOTAL <br /> APPROVAL <br /> Car,fen <br /> 1 X30 Days 31.:8 Days S1 90 l 3aj+s L9ust.9O Days <br /> 0.00 0.00 0.00 INVOICE TOTAL: r$711.94 <br /> ME$SAG1E GEfVTER <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 /> E073 STE001 STE00102.NTP 00001004 1 00001024 - - DETACH AT PERFORATION AND RETURN BOTTOM PORTION WITH YOUR PAYMENT <br /> • - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . <br /> ❑ American Express ❑ VISA ❑ MasterCard ❑ Discover <br /> 51.e v i cyc3 Credit Card Account Number Expiration Date <br /> Experts in Infection Control and Healthcare Compliance Services <br /> 9188 Glenoaks Blvd,Suite 300 Signature <br /> Sun Valley CA 91352 <br /> 0006018848 0002572610 0000071194 0 030005 <br /> REMITTANj5 Please write Amount Paid below <br /> Ilelnele'eeellnel'nl'Heel'eeeelle'Inleeelnel'llnee'leel PLEASE STERICYCLE INC <br /> Sunbridge Manteca SEND PO BOX 79145 <br /> Tabatha PAYMENT <br /> 410 Eastwood Ave To PHOENIX AZ 85062-9145 <br /> Manteca CA 95336-3167 I'eeln'[lellnuf'tnelellminuel'elnlelelnleelelelute'I' <br /> 00001004 43 9854 <br /> nvoice Customer Date: Invoice Amount <br /> vumber: 0002572613 Number: 6018848 01/01/2004 Amount: $711.94 <br /> Paid: $ <br />