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4�0* Sterlcycle <br /> • Account# <br /> Reason Code <br /> STERICYCLE, INC. BIOMEDICAL WASTE SERVICES AGREEMENT <br /> Billing Name and Address Service Name and Address <br /> Name: Gambro Health Care/San Joaquin Name: Gambro Health Care <br /> Address: 115 Columbia Address: 3115 W.March Lane. _ <br /> City/State/Zip: Aliso Viejo,Ca 92656-1458 City/State/Zip: Stockton,Ca 95219 "� <br /> Phone: 949-831-0900 Fax: Phone: 209-955-7527 Fax: 20q --7,53 <br /> Contact: 14/P Title: Contact: Myrah Graham Title: *bqr bre cf'' <br /> Rate Structure: Minimum charge of$60.00. $0.41 /Ib.for biohazard $0.62/lb for pharmaceutical waste <br /> Service Description: —Pick-up TB14(44 gallon biohazard)or TB49(37 gallon biohazard)twice weekly. <br /> Hazardous Waste(YIN): NO <br /> Date of Service Agreement: 9/24/02 <br /> By signing in the space provided below, the Customer.acknowledges having read and understood that Customer is <br /> bound by the terms and conditions on all pages of this Medical Waste Services Agreement. <br /> Stericycle, Inc. C stomer <br /> Signature: Signature: , <br /> Name Printed: Bill Avery Name Printed: y'�f <br /> Title: MAE Title: /�- <br /> Date: 9/24/02 Date: <br /> Inter-Office Use Only <br /> Salesperson BAVERY Segment Code: SEG21 <br /> Service/Other <br /> Type of Agreement(check one) ❑ New ❑ New Service Location ❑ Change ❑ Renewals <br /> Term of Agreement Months Date Sent Date Received <br /> Default Container Type <br /> Tax Exempt: ❑ Yes ❑ No If Yes, ID# <br /> (Copy of paperwork must accompany contract) <br /> Purchase Order# Date Valid From _ to <br /> Frequency of Service: Inventory Service Area(REQUIRED) <br /> Stop Charge$ Minimum Charge$ Record Retention Fee$ <br /> Recurring <br /> Charge$ Description: <br /> Automatic Credit Card Payment ❑YES ❑NO If Yes, individual to <br /> Other Service Locations: contact: <br /> Routin Information(Operations Department <br /> Date Cycle Begins 10/1/02 Route# 405&405 <br /> Day of Service ❑ Mon X Tue ❑ Wed ❑ Thu X Fri ❑ Sat ❑ Sun <br /> Map Page/Grid# Routing Comments(Hours) <br /> ETS ECO <br /> ?age l.,ofa3_t <br />