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Page: 1 of 1 <br /> P <br /> 0 <br /> Sunbridge Manteca <br /> Experts in Infection Control and Healthcare Compliance Services Tabatha <br /> 9188 Glenoaks Blvd,Suite 300 410 Eastwood Ave <br /> Sun Valley CA 913524 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 02/01/2004 0002615879 6018848 Net 30 Days <br /> AAA1tkI1 E51 <br /> DATE Q?Y E3ESCRtP f10N BVEIHT(t B} PRICE UtM TOTAL <br /> dNUMBER <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 /> 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 /> 01/06/2004 MDFROOOVM7 1.00 1 44 Gal Tub Bio , CT 12.7 lb 9.40 0.000 EA 0.00 <br /> 01/12/2004 MDFROOOWHN 1.00 44 Gal Tub(Bio), CT 12.7 1b 18.40 0.000 EA 0.00 <br /> 02/01/2004 1.00 Steri-Safe Standard-Monthly 0.00 711.940 EA 711.94 <br /> SITE-SUBTOTAL-AMT: $711.94 <br /> SITE-TOTAL-TAX: $0.00 <br /> SITE-TOTAL-AMT: $711.94 <br /> FACILITY ss <br /> VENI✓lOR v } <br /> INVOICE 4 (a <br /> ACCT AMOUrd t <br /> I 6 7� <br /> n V £x1Q Lays C9ver 9Q Days <br /> 0.00 0.00 INVOICE TOTAL: $711.94 <br /> t <br /> TGT AL ✓� Tl ��t A <br /> r <br /> f3 S <br /> C.l!1^11- , I <br /> For your 2004 service. <br /> P <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 /> STE073 STE001 STE00101.9TP 00007592 000 7741 DETACH AT PERFORATION AND RETURN BOTTOM PORTION WITH YOUR PAYMENT <br /> - - - - - - - - - - - - <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . <br /> ❑ American Express ❑ VISA ❑ MasterCard ❑ Discover <br /> I ( Credit Card Account Number Expiration Date <br /> 'A <br /> r, .; xperts in Infe on Control and Healthcare Compliance Services <br /> a <br /> Signature <br /> 9188 Glenoaks Blvd,Suite 300 <br /> Sun Valley CA 91352 <br /> 0006018848 0002615879 0000071194 3 030003 <br /> � F Please write Amount Paid below <br /> �'1'1/1�1'III�I111"/1'1111/'llltl"I'�II�IIII/11�"�1i11'1®1' PLEASE STERICYCLE INC <br /> Sunbridge Manteca SEND PO BOX 79145 <br /> Tabatha PAYMENT PHOENIX AZ 85062-9145 <br /> 410 Eastwood Ave TO <br /> Manteca CA 95336-3167 I'I111Ilel/II11n"/IBI'AI�1�11111"1'I1�1'I'11'I1�1'1'1/11"' <br /> 00007592 37 7592 <br /> Invoice Customer Date: Invoice Amount <br /> Number: 0002615879 Number: 6018848 02/01/2004 Amount: $711.94 <br />