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HomeMy WebLinkAboutContract No. 2013 2484 2013. 2484 11t:S LLC vision: To be the trusted provider of environ- mental services { within the region, based on out- standing customer service and com- petitive rates, To assist our cus- tomers in achieving their mission and goals by providing quality environ- AN mental services in a cost-effective ! manner. Non-Hazardous Pharmaceutical And Controlled Substances Waste Disposal Service MIECOMMUMM - MZ211111 M 1 001 Healthcare Environmental services LLC is a Lice x the North Dakota Three sizes of Y waste management company headquartered in containers available; Dep 'Unit tatesEnvir nrncithc Fargo, ND with offices in Valley City and United States Bnvirann�ental Protection Agency Bismarck, ND. In business since 1977, HES • 8 gallon container LLC serves local, regional and national • 12 gallon container clients. , 18 gallon container Clientele includes, hospitals, clinics, Prices are all long term care facilities and medical re- inclusive. Healthcare Environmental long facilities. Services LLC � No long term contract Handling of non-hazardous pharmaceutical required. 1420 40th Street North waste including expired drugs as well as Incinerated controlled Fargo ND 58102 narcotics. All materials are treated at substances waste is our company owned EPA Title V incinerator. priced per pound. Pick up or drop off 888-282-7374 7011 Free Complete services include: manifest, con- available. Witness 701-282-7373 tainer, transportation, waste processing burns welcome. 701-282-0801 Fax and disposal . kv 1W Healthcare Environmental Services HEALTHCARE E 1420 40111 St, N. ���� ®� �°'"` Fargo,ND ENVIRONMENTAL 888.252-7374 awSERVICES, LLC 701-282-7373 FAX:701-282-0801 Billing Information SERVICE AGREEMENT., CONTROLLED SUBSTANCE Customer Name: z'- Address. _mss/s-k` City, State and Zip Code:f L ^� i/ ,s _ Az/a Contact Person: Telephone Number: PE 7o 6 - FY©p Fax Number: _76? -&'� �(_ E-Mail Address: 4_SA)n y, Za t w. iL,-44-s lk.-v, a 5 Pick-Up Information (if different than billing information) If pick-up information is the same as billing information,please circle yes Customer Name:... Street Address: City, State and Zip Code: Contact Person: Telephone Number: Rates. $.50 cents per pound with a $50.00 minimum (price all inclusive) Controlled Substance Price includes manifest, disposal, and record keeping. Special Instructions: Either party with thirty(30) days prior may cancel this agreement with written notice. Service on will call basis: customer calls when needing service. TERMS AND CONDITIONS By signing in the space provided below,the customer acknowledges having read and that it is bound-by the terms-and conditions above-as well as conditions-stated in HITS Customer Manual, customer must comply with all applicable government regulations,. HESI Representative:Chad Wol HES1 Representative(Signature): •� __,.: Customer Company Name: Authorized Signature: Name(Please typ ar print): rip 'title(Please type or print):---- Date of Agreement: lJ! HESI Account#(office use only): 1420 40 Street North - Fargo, ND 58102 01811)282-7374 e (701)2lQ-737.3 o Nix(701)?82.ot3O I