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:- . <br /> No. 841. <br /> 4 AMERICANDATE May 4, 198' <br /> ENVORONMENTAL. MANAGEMENT COfaR. <br /> 11855 WHITE ROCK FIOAD,RANCHO CORDOVA,CA 95670 <br /> (916)985-6666 <br /> BIOHAZARDOUS WASTE DISPOSAL SERVICE AGREEMENT <br /> Bill To Customer Name <br /> Vienna Convalescent Hospital ' <br /> Billing Address Service Address <br /> o-* <br /> City.State and ZIP �{ City,State and ZIP <br /> Payment Contact-Name Service Contact-Name <br /> Phone Number Phone Number <br /> • <br /> Collection containers with finers which meet State requirements for contai ment f biohazardo waste - �' (sizes).' _ <br /> Collection of filled containers Y t o f C frequency). <br /> • <br /> Disposal according to the C.A.C.Title 22 regulations. rm <br /> Service to include collection and disposal at the following rales: <br /> $35.00 per large <br /> $30.00 per small <br /> 4 5 p .• <br /> C <br /> r r 4A <br /> � '! :� fflay+ Ei.•: <br /> C. <br /> Date Service To Commence: <br /> e e• • <br /> Special emergency pick up service includes an hourly ch4Mfpr one biohazardous technician and truck al"book ratits"per hour plus the above disposal charges. <br /> Consultation with customer's staff charged @$ 1 7`�' per hour.Each session covers biohazardous/intectious <br /> waste segregation,collection•and storage strategies,definitions and Title 22 regulations. <br /> BY SIGNING THIS AGREEMENT,YOUACKNOWLEDG OU HAVE READ AND UNDERSTAND THE TERMS AND CONDI NTHEREVERSE SIDE OFTHIS AGREEMENT AND THP PRICES <br /> SPEC ICA NS ARE HER Y ACCEPTED AND SE E SHALL BEGIN ON"DATE SERVICE TO COMMENCE." <br /> L A ,U� <br /> DATE DATE V I <br /> AUT1404,IZED SIGNATURE CUSTO AEA44G THORIZED SIGNATURE <br /> LISA MUSS, Technical Sales Representative <br /> PLEASE PRINT NAME AND TITLE PLEASE PRINT NAME AND TITLE <br />