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Page: 1 of 1 <br /> pat - , <br /> ^ Manteca Care & Rehab <br /> Experts in Infection Control and Healthcare Compliance Services Accounts Payable <br /> 9188 Glenoaks Blvd,Suite 300 410 Eastwood Ave <br /> Sun Valley CA 91352 INVOICE 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 01/31/2004 0002653302 6059477 Net 30 Days <br /> MANIFEST <br /> BATE QTY DESCRIPTION WEIGHT(LB) PRICE U/M TOTAL <br /> NUMBER <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 Swift Ave,Fresno,CA 93722 Terry Shain Deputy Weighmaster <br /> 01/14/2004 1 1 1.00 1 Steri-Safe Standard-Monthly 0.00 1 479.030 EA 479.03 <br /> SITE-SUBTOTAL-AMT: $479.03 <br /> SITE-TOTAL-TAX: $0.00 <br /> SITE-TOTAL-AMT: $479.03 <br /> 61�Bays fiver 9D Days <br /> 0.00 1 0.00 INVOICE TOTAL: r$479.03 <br /> FACITS PM IxFN i <br /> Y T your 2004 service. <br /> 6 INVOICE <br /> DEBT ACCT AriiOt)t,47 <br /> 102 `41-JI i <br /> [\A <br /> i) DETAILED ABOVE (INFECTIOUS MEDICAL WASTE) HAS BEEN TREATED IN ACCORDANCE <br /> -- aL REGULATIONS GOVERNING THE TREATMENT OF SUCH WASTE. A COPY OF THIS <br /> eLOGS WILL REMAIN ON FILE WITH THE COMPANY. <br /> STE073 STE001 STI " �� ' )RETURN BOTTOM PORTION WITH YOUR PAYMENT <br /> - - - - - - TOTAL . - - - - - - - - - - - - - - - - -p - - - - - - - - - - - - - - - - - - - - - - - - - <br /> q 79.03 .: <br /> --� 3 <br /> :tai PJ'vp m American Express VISA MasterCard Discover <br /> aliance Services Credit Card Account Number Expiration Date <br /> Signature <br /> Sun Valley CA 91352- <br /> 0006059477 0002653302 0000047903 3 030004 <br /> � Please write Amount Paid below <br /> I{elne{e{rnllaeellee{{nn{{®eu{{®{{n{n®{ne{{{{eue{{®eI 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 {In{n{®{®{Iun{{en®{tI{®{nnell®InIelaln{nI®Ielnu{I1 <br /> 00000217 <br /> Invoice Customer Date: Invoice Amount <br /> Number: 0002653302 Number: 6059477 01/31/2004 Amount: $479.03 Paid: S <br />