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10/24/2003 08:53 N0.944 P002 <br /> G <br /> (Vti e ��h Dim <br /> Ste ricyc le 1-a e �J (°t�S �" c) <br /> Account# '+II <br /> ?' r Reason Code € <br /> STERIC'YCLE, 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: 116 Columbia Address: 3115 w.March Lane. <br /> City/State/Zip: Aliso Viejo,Ca 92656-1458 City/state/zip: Stockton Ca 96219 <br /> Phone: 949-831-0900 _ Fax. Phone: 209-955-7527 Fax <br /> his <br /> Contact: _ASP Title: Contact: ^Mvmh Graham _ Title: <br /> 1 <br /> Rate Structure: Minimum charge of$60.00 $0.49 /lb for biohazard.$0.62 lib for harmaCeuticai waste. <br /> Service DescrligUon: pick-vp TB�llon biohazarxi)or T849(37 ga!!on biohazard)twice weekly. <br /> Hazardous Waste(YM): NQ ' <br /> Date of Service Agreement: 9/24102 <br /> By signing In the space provided below, the Customer,acknowledges having read and understood that Customer is <br /> bound by the terms and conditions on all pages of this Medical Waste Services Agreement. <br /> C stomer <br /> Steticycl+s, Inc. <br /> Signature: �''� c✓CT <br /> Signature: t <br /> Name Printed: Bill Avery Name Printed: l <br /> Title_ MAE TWO: 1 �,' / . <br /> Date: 9/24102 Date: ( �•W <br /> Intar-Offtoe Use Oni <br /> Salesperson SAVERY Segment Code: SEW <br /> ServicelOther <br /> Type of Agreement lcr,vcic or,e> ❑ <br /> New ❑ New Service Location ❑ Change ❑ Renewals <br /> Term of Agreement _ Months Data Sent )late Received <br /> Default Container Type <br /> Tax Exempt, 11Yes ❑ No if Yes,I])# (Copy of Paperwork must accompany Contract) <br /> purchase Order# _ Date Valid From to <br /> Frequency of Service: Inventory Service Area(REQUIRED) <br /> Stop Charge$ Minimum Charge$ Record Retention Fee$ , <br /> Recurring Deserlption: <br /> Charge$ Automatic Credit Gard Payment ❑YES NO if Yes,individual to <br /> ether Service Locations: contact <br /> Routing Information(operations Department) <br /> Date Cycle Begins 10!1/02 Route# 405&405 <br /> Day of Service ❑ Mon X Tue ❑ Wed ❑ Thu <br /> X Fri Q Sat ❑ Sun <br /> Map Page/Grid# Routit3g Comments(Hours). <br /> ETS EC <br />