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MAY -27-2009 01:2e From: ENSERV.. IteddinMg m4rc waste salmons Service Agreement A'Mm6e . Comp any Service Address ❑ Check if Additional Locations & Attach Addendum To:12093341709 Pa9e:2,2 Internal Account# 039436 Use Contract Type Conversion Only Promo Code NIA i Classification Moo Primary Customer Contact _ amsWine Gauntry Care Center Name Paul Gross Address 329 West Turner Rpad -__ __.�_- - L___.. Title Administrator _ � '.' 9rator City Lodi - �,...s__. J State , CA Zip i95z40 17 Phone 209.334.3760 Phone 209-334.3760 Fax ; 209.334-1709 E-mail gross@winecountrycarocenter.m Billing Address ❑ Bill to Parent Account# N/A Additional information Name _..•......._... V__" -. __ -_ __... Office Hours Address f ..._..._-.......__._,,,..._...___.._.__... � ( - A # of EmployeesLLabsLRooms r L, Tax Exempt # NLA T city �� State Zip Affiliation HPSI Contact Phone Fg ®! SIC Code 8051-6kiaetl Email ] ❑ Check for Electronic Invoice J Purchase Order —� SAEg§ery Programs: Premium - OSHA Consultant (see addendum) El Practice Optimizer- Internet based Premium - HIPAA Consultant (see addendum) ® One -Stop Compliance Portal Premium - Online BBP Training practice management consulting ® PLUS Regulated Medical Waste Containersinduded per stop: Additional Container Charge: $ fig Frequency: W_eekl[ 11 Ina RINI C] PLUS Dental Hazardous Waste ONE tmnlainer each per stop Additional Container Charge: $ _ Frequency: ❑ Fixer ❑ Developer ❑ Lead Foil ❑ Scrap Amalgam ® X -Ray Films 5 gallonsper conlaim 5callonepereon%ner R Ions pereonwftr2 ollnn; rAntalner 5 r contalner Monthly Service Fee (for all checked services above): $ 852.00 Set -Up Fee $ 0.00 Unscheduled Pickup Fee $ 75.00 Add'ational Waste Services Pricing: Pricing for QK container (containers not included In pricing) Frequency: _. ❑ Chemotherapy $ ® Pathological $ Non-RCRA Pharmaceuticals $ 48.50 ❑ - $ _ 13_$ Up to 10 gallons per conlahma per conlainm, _ per conta®d Effective Contract Date; May 9, 2009 <-Billing begins on this date Requested Date of First Pickup: 1 Temh and Rgnewat Sublect to the provisions below, the term ("Term") of this Agreement shall be 36 (thlay-six) months from Oto Effective Date of this Agreement The Agreement shall automatically renew for successive terms equal to the original term unless either party notifies the other patty in writing of its desire to terminate this Agreement Such notice of termination must be given at least 60 days prior to the renewal data. All Renewals shag be governed by the temps and condition; contained hereln. 2. Additional 1 crams anal Condltons. Additional terms and conditions related to this Agreement are located on the $AFEsery webslto "_.%I randsnhaiter.aom, To obtain these terms and conditions ctck on the CONTACT button of the home page of the SAFEsery website. Then click on General Terms and Conditions. All contractual terms related to this basic Agreement will be displayed for review by Customer. Itiebt m Rescind this Agreerrignt. Within three (3) days of signing the written copy of this basic Agreement, Customer must review the General Terms and Conditions and notify Ensery in writing if Customer does not accept those Terms and Conditions. Customer rnpgt send the written notice of rescission (or non-acceptance) by mail directly to Ensery at Contract Administration, 6565 West Loop South, Suite 400, Bellaire, Texas 77401 or by FAX to Contract Administration toll free at 1.868.495.0120. Rescission w6 be effective as of the date of postmark or as of the date the FAX is received. Ams g below the mprese a of each pa acknowledge that he/she Is an authorized officer or agont of hi6lher respective party and has the full authority to bind Its respective party moment and Its condi Include Waste Accoptanoe Protocol) that are set forth on the website and are incorporated In this Agreemont, Please read carefully nfng this agree gr s d ere prohibited by applicable law. G l Customer Signature .. pilo / Printed Name and Title ENSERV Representative Signatum Date Adrienne Barnes/Regional Account Execuctive Printed Name and Title Cardholder's Name; Credit Card Number: Card Expiration (Mwyy Cardholder's Signature: r_W4;4-9440av CoNmufrm