Laserfiche WebLink
ACCOUNT NUMBER: 885-15220007 <br /> W <br /> EFFECTIVE DATE: June 30,2020 <br /> WASTE MANAGEMENT <br /> Healthcare PERSON SUBMITTING FORM: Julie Kunz <br /> SolutionsSALES PERSON: Julie Kunz <br /> MGR APPROVAL: Jeff Norton <br /> CURRENT DATE: 6/302020 <br /> SERVICE CHANGE FORM <br /> REASON CODE: INP-Increase in Service Permanent acct <br /> Customer: Everett Fire Department Billing Name: Everett Fire Department <br /> Station 5 <br /> Service Address: 1600 Madison St Billing Address 2930 Wetmore Ave#7A <br /> City: Everett State: WA Zip: 98203 City: Everett State: WA Zip: 98201 <br /> Phone No.: Fax: Phone No.: Fax: <br /> Contact: Mayor Cassie Franklin Contact: <br /> Email Email <br /> Pickup <br /> O Quantity Container Size Waste Type Pricing Amount$ Frequency o SUN MON TUE WED THUR FRI SAT <br /> • O <br /> L 1 17G CESQG-Pharma Each $ 2s9.00 On CALL COo <br /> C <br /> $ m <br /> D $ Q N , <br /> $ <br /> PickuQuantity Container Size Waste Type Pricing Amount$ Frequency cy o SUN MON TUE WED THUR FRI SAT <br /> Co <br /> $ Co <br /> E - <br /> a• t• o <br /> W $ g � <br /> Special Notes: <br /> Please add pharmaceutical waste services to this account with on call service. Thank you <br /> By Signing this change form,customer agrees to the service changes above. All other terms and conditions of the original service <br /> arexti d ent-F remain unchaaen ed. <br /> X a-, 3 .2--d <br /> Cust atureI R�a2 Date <br /> ST: <br /> Office of the City Attorney <br /> APPROVED AS T0 FORM AM <br /> David C.Hall,City Attorney City Clerk <br /> Collection template(11/15/11) <br />