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***IMMEDIATE ACTION REQUIRED*** <br /> 400,16 A S ericy lw 1)Read the attached Terms and Conditions along with the Waste Acceptance Policy. <br /> s P ,Itfte.,Bd t; 2)Please Fax Agreement to Stericycle. <br /> Regulated Medical Waste Services Agreement <br /> Service Address: Billing Address: <br /> Name: Canvas Tattoo Name: Canvas Tattoo <br /> Address 1: 304 W Harding Way Address 1: 304 W Harding Way <br /> Address 2: Ste B Address 2: Ste B <br /> City/State/Zip: Stockton,CA 952045608 City/State/Zip: Stockton,CA 952045608 <br /> E-Mail: canvas tat2@sbcglobal.net E-Mail: canvas_tat2@sbcglobal.net <br /> Phone#- (209)981-0814 Fax#: xx <br /> Sales Rep: Dean Zerby GeneratorID#: <br /> Generated By: Dean Zerby Contract Number: SRCL-00781626 <br /> Effective Date of Agreement:6-1-2015 Frequency:4 Stops Per Year <br /> SERVICE DESCRIPTION: <br /> Medical Waste Service Including:Packaging Materials,Tape,Labels,Treatment,Destruction&Documenation <br /> RATE STRUCTURE : BOX CHARGE(S)+STOP CHARGE=PICKUP FEE <br /> Box Charge: $25.00 (please adhere to proper weight limits on all containers) <br /> Stop Charge: $100.00 (charged each time we stop at your facility) <br /> Minimum Pick Up Fee: $125.00 (min 1.0 box(es)agreed by the Customer+stop charge) <br /> No Waste Fee $65.00 (Charged when driver makes pickup and office is closed during normal business <br /> hours or there is no waste for the driver to pickup) <br /> Record Retention Fee $5.00 (Manifest and waste archive) <br /> Other Additional Fee <br /> Explanation for Other Fees: <br /> By signing below I acknowledge that I am Customer's authorized officer or agent and that I have the authority to bind Customer to this Agreement. <br /> Customer agrees to be bound by the terms and conditions that appear on the second page hereof and comply with Stericycle's Waste Acceptance Policy, <br /> both of which are integral parts of this Agreement. <br /> CUSTOMER: Name�M�eliss�a Santos Title owner <br /> W. <br /> Mzlissa� L <br /> 20 <br /> (Jun 2, 15) Date un ,2015 <br /> STERICYCLE:XZeAy+ Zex,61y Name itle HCC Date Jun 2,2015 <br /> Dean Zerby(Jun 2,201 ) <br /> 4010 Commercial Ave.,Northbrook,IL 60062 Phone:(847)943-6596 Fax: <br /> Offer Expiration Date: 6-9-2015 <br /> Office Use Only:Code#:RX-]A.PC-IA.FD-1.0 <br /> Melissa Santos Dean Zerby <br /> E-signed 2015-06-02 03:36PM PDT E-signed 2015-06-02 05:37PM CDT <br /> canvas_tat2@sbcglobal.net dzerby@stericycle.com <br /> owner HCC <br /> Leamanaa P4 Document Integrity Verified Adobe Document Cloud Transaction Number:XZ6CHSHE6D43L5B <br />