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Page: 1 of 1 <br /> ` • i <br /> Stericycle° <br /> Manteca Care & Rehab <br /> • • Experts in Infection Control and Healthcare Compliance Services MantecaAccountare &Payable <br /> • 9188 Glenoaks Blvd,Suite 300 410 Eastwood Ave <br /> Sun Valley CA 91352 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 02/29/2004 0002691559 6059477 Net 30 Days <br /> MANIFEST <br /> DATE QTY <br /> DESCRIPTION WEIGHT(LB) PRICE tJJM 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 /> 02/16/2004 MDFR0010PO 4.00 12 Gal Pharm , 0 Tare Wt. 0.00 0.000 EA 0.00 <br /> 02/16/2004 MDFR0010PO 1.00 44 Gal Tub(Bio), CT 12.7 lb 61.40 0.000 EA 0.00 <br /> 02/23/2004 MDFR0011KA 1.00 44 Gal Tub(Bio), CT 12.7 lb 30.90 ( 0.000 EA 0.00 <br /> SITE-SUBTOTAL-AMT: $0.00 <br /> SITE-TOTAL-TAX: $0.00 <br /> SITE-TOTAL-AMT: $0.00 <br /> Cum ttt 1730.Days 3 i,60 Days Sy�JO:Days Over 90 Dajrs <br /> ... <br /> 825.001 1,475.391 0.001 0.001 0.00 1 INVOICE TOTAL: $0.00 <br /> MESSAGE CENTER.:: <br /> THANK YOU FOR KEEPING YOUR ACCOUNT CURRENT. <br /> Your invoice may reflect a rate adjustment for your 2004 service. <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 STE00102.MTP 00002402 1 00002801 DETACH AT PERFORATION AND RETURN BOTTOM PORTION WITH YOUR PAYMENT <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . <br /> ❑ American Express ❑ VISA ❑ MasterCard ❑ Discover <br /> • Stericycle® <br /> 4010,000 <br /> Experts in Infec on Control and Healthcare Compliance Services Credit Card Account Number Expiration Date <br /> Signature <br /> • 9188 Glenoaks Blvd,Suite 300 <br /> Sun Valley CA 91352 <br /> 0006059477 0002691559 0000000000 3 030005 <br /> REMITTANCE. Please write Amount Paid below <br /> 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 <br /> 00002402 40 9375 <br /> Invoice Customer Date: Invoice Amount <br /> Number: 0002691559 Number: 6059477 02/29/2004 Amount: $0.00 Paid: $ <br />