Laserfiche WebLink
am <br />Medical Waste Systems <br />ACCOUN NT O: C 5 6 g 5 <br />NEW ACCOUNT <br />NEW SERVICE LOCATION <br />BILLING INFORMATION <br />LOCATION CODE: <br />REINSTATE CUSTOMER <br />CHANGE SERVICE LEVEL <br />SERVICE LOCATION INFORMATION <br />CUSTOMER NAME: C^Lz5, t LY) Q i} <br />STREET NUMBER: <br />STREET NAME <br />CITY:r 1 <br />CITY:1/ d / PHONEAq• <br />.� <br />Aivb <br />NUMBER <br />z <br />OF •ICES REQUIRED: <br />a <br />4, <br />SERVICE DESCRIPTION <br />Customer Tax Exemption Number (If Applicable): A) <br />Service Begins Ott:[ ;Service Schedule: -0 13 ETIme(s) per day ee montf'i <br />Number of Containers: Type of Container: 90 0.� (�1� <br />I <br />I <br />Recommencement Rate: <br />Special Instructions: _SJ A iJ.l-1 rlt'_ i f r.y)� <br />Date of Agreement: 0 <br />TERMS AND CONDITIONS <br />BY SIGNING IN THE SPACE PROVIDED BELOW, THE CUSTOMER ACKNOWLEDGES HAVING R!% AND THAT IT IS BOUND BY THE TERMS AND CONCH <br />ABOVE AND BELOW -ON THIS PAGE AND CONTINUING ON THE REVERSE SIDE OF THIS PAGE,/�r- <br />"CONTRACTOR" TOMER NAME) <br />�!BY (SIGNATURE): <br />(SF�---�w <br />• " A""' " 6 J V'_`S=y A/ NAME (PLEASE YPE OR PRINT) <br />(NAME OF OPERATING BROWNING -FERRIS INDUST IES SUBSIDIARY) <br />BY/TITLE TITLE (PLEASE TYPE OR PRINT): Air <br />ARTICLE I <br />DISPOSAL SERVICES <br />Customer shall provide to Contractor and Contractor shall collect and remove from Customer's premises, treat and/or dispose of all "Biomedical Waste" generated by Customer in accordance with the terms of this r <br />The term "Biomedical Waste", as used herein, shall include only those wastes (i) defined by the United States Environmental Protection Agency (USEPA) as infectious wastes in its Guide for Infectious Waste Ma <br />#EPA/530-SW-86-014, May 1986, and arty other wastes identified as infectious or similar wastes in any other applicable federal, state, county or municipal laws, regulations and guidelines, and (III "Chemotherapy W <br />known as antineoplastic or cytotoxic waste). The term "Chemotherapy Waste", as used herein, means discarded items which have been contaminated by chemotherapeutic drugs or antineoplastic agents, provided <br />items, including vials and syringes, shall be empty or contain only such trace amounts of chemotherapeutic drugs as are allowable under applicable federal, state, county or municipal laws, regulations and guidehrlr <br />be considered waste. The term Biomedical Waste specifically excludes corrosive, reactive, radioactive, toxic (except toxic material or waste listed as an antineoplastic agent in Section 10.00 of the America <br />Formulary Service published by the American Society of Hospital Pharmacists), and other hazardous wastes and substances as defined in any applicable federal, state, county or municipal laws, regulations and guide <br />