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Accou#ite# 60181,52-003 <br /> Stericycle® STERIeSAFE mSERVICE AGREEMENT <br /> " ��" elh�i5 lnt7ts,aS-�tlhiS. day� � by.and <br /> Service Address <br /> _ am CarefT acxi Ine. ,a ware corporaticxs. <br /> Billing Address(If Different) <br /> Address 425 ftLeft SkM Ste A Nam Gwnbro Health Care/Tracer <br /> Address 115 Columbia <br /> City/state/zip TIMM Ca 95376 <br /> E-gall Cityfstatelzip Aliso ViCio, Ca 2MM-1458 <br /> Phone(M$63 }3g8 Ext Fax 2{ 4�M-!£l 1 Ext Fax C)= <br /> contact t:a Twe Laura Simpson Title <br /> The parties agree as follows: <br /> I. The Effective Date of this agreement is )/I&o CEffective Date`). <br /> 2. Stericycle shall remove and dispose of Custorners Biomedical Waste subject to the terms and conditions" set forth below. <br /> 3. Steric de will provide addil:ional compliance services based on the program lei Customer has . <br /> 4, The first removal and disposal of waste from Customer shah occur aft the scheduled number of weeks <br /> has elapsed after the Effective date of this Agreement(d Program Level AND$per ) <br /> per Month Only P ($872. 0 <br /> Primary Tuts Description: 44 gallon tuts Containers charged at a separate rate are: <br /> Dental Customers Only—Not Available In All Areas(4 ) Dental Waste Included II YEs 0 mo Sdieduk(lf cliff) <br /> Service /Year( ) ❑ 0 52 ❑26 El 13 ❑6 ❑4 <br /> (lx/wk) (ix/2wks) (1x/4 s) (lxf8wks) (Ix/12wks) <br /> Sdmdule( ) 19 MONTHLY* ❑QUARTERLY ❑ANNt1A-LY <br /> thll payrrrerrt available for pickup Fre4 cy greater Umn 13 per year <br /> AMillionall Pkkup ChaMe ($175, 14wdmum Containers Per Pick up 4 for fib Wdb <br /> By signing I admowledge t1wit I am s authorized officer or agent and that I have the audiority to bind <br /> Customer to his agreement Customer agrees to be bound by the terms and amullitions that appear an the second page <br /> hereof and comply with SterlcycWs waste Acceptance Polky,both of which are integral parts of this agreement <br /> CUSTOMER: 7f T'ttfe -s-lcr' <br /> r <br /> Sales Persm <br /> Patti Piccardo STERICYCLE USE ONLY—Complelt Full Form <br /> T f BOB PPICCARDO Type of Agrmnent(Check Cane) ❑New ❑New Ownership—Account#to LSE <br /> Term of Agreement 660 Months Q Renewal ❑Additional Site M Service Change <br /> Segment Code Type 1 SEG-18 Home Health Care Type 2 Type 3 Type 4 Type 5 Type 6 <br /> TaxExempt: ❑ If YES,ID (copy must accompany paperwork) <br /> Purchase Order(if applicable) From__ —J 04 to—/.—I_ ALLPHARM Included ALLPATHCHEMO Not Included <br /> PharmacmUcal Waste Acceptance Attached 0 YES ❑NO <br /> Routing Information LQRewt1m DenadmeW., <br /> In —Container Type TB14 Qty 8 Type RX12 Qty 1 Norse❑ <br /> Route# Cycle Begins Date_!_/04 Day of Service Q M ❑T Q W ❑Th [] F <br /> District# RC-5064 Dental Code None Routing Comments(40 char. max) <br /> e Hour ur Comments Or M 8-5 T 8-5 W 8=5 Th 85 F 8-5 Sa cWed Su dosed Lunch Hour <br /> This offer Will E=re can: 711104 <br />