Document:

Exhibit 10.9
                                                                    ------------

                                FOURTH AMENDMENT
                       TO THE CONTRACTOR SERVICE AGREEMENT
           BETWEEN THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
                                       AND
                      ENVIROCLEAN MANAGEMENT SERVICES, INC.

This fourth  amendment (the "Fourth  Amendment")  is to the  Contractor  Service
Agreement (the  "Agreement" or the  "Contract")  between The University of Texas
Medical Branch at Galveston,  a component institution of The University of Texas
System  which is an  agency  of the State of  Texas,  ("UTMB")  and  EnviroClean
Management  Services,  Inc.  ("EMSI') and which  Agreement  became  effective on
December 8, 1995.

         WHEREAS,  UTMB and BMI  Services,  Inc.  entered into the  Agreement to
provide medical waste disposal services for UTMB on December 8, 1995;

         WHEREAS, BMI Services, Inc. assigned its rights and responsibilities to
EMSI on March 4, 1996;

         WHEREAS,  UTMB and EMSI,  Inc.  have  amended  the  Agreement  on three
previous occasions;

         WHEREAS,  UTMB AND EMSI desire to amend the  Agreement to allow EMSI to
provide  security  other than a performance  bond as  contemplated  by the Third
Amendment;

         NOW THEREFORE,  for and in consideration of the above-stated  premises,
the payments,  and the covenants and agreements herein contained,  UTMB and EMSI
do agree that the Agreement is amended as follows:

The Third Amendment's Attachment A is amended as follows by adding the following
Section 1.4.5:

1.4.5. In lieu of the required $200,000  performance bond,  Contractor may elect
to fund an account  ("Retainage  Account")  which  shall be retained by UTMB and
which UTMB shall return to Contractor upon Contractor's  faithful performance of
the Agreement.

In the event  Contractor  elects to fund the Retainage  Account in the amount of
$125,000 and provided it maintains its current performance bond of $75,000, UTMB
shall  withhold  monthly  an amount  not to exceed Ten  Thousand  and  no/100ths
Dollars  ($10,000)  from  the  proceeds  that  UTMB  would  otherwise  remit  to
Contractor until the Retainage Account equals $125,000.

In the event  Contractor  elects to fund the Retainage  Account in the amount of
$200,000,  UTMB shall withhold  monthly an amount not to exceed Fifteen Thousand
and no/100ths  Dollars  ($15,000)  from the proceeds  that UTMB would  otherwise
remit to Contractor until Retainage Account equals $200,000.

<PAGE>

Contractor  may  elect to  provide a Letter  of  Credit  ("LoC")  in lieu of any
Retainage  Account  provided the LoC  satisfies  the  requirements  of the Third
Amendment's  Section  1.4 and  subject to the  approval of the Office of General
Counsel of The University of Texas System and UTMB. UTMB's approval shall not be
unreasonably withheld.

UTMB shall  return the  Retainage  Account to  Contractor  promptly in the event
Contractor  tenders to UTMB either the required  performance bond or LoC, but in
no event no later than thirty (30) days.

Contractor may elect to provide any combination of a LoC, Retainage Account,  or
Performance  Bond to satisfy the requirements of the Third  Amendment's  Section
1.4.

Except to the extent  specifically  modified by any properly executed amendment,
all the terms and  conditions  of the Agreement as amended are in full force and
effect,  and the parties by their  signatures to this Fourth Amendment do hereby
confirm and adopt the Agreement as amended by this Fourth Amendment.

ENVIROCLEAN MANAGEMENT                         THE UNIVERSITY OF TEXAS
SERVICES, INC.                                 MEDICAL BRANCH AT GALVESTON

By:  /s/  Matt Fleeger                           /s/ Richard S. Moore
    -----------------------                    ---------------------------------
Title: President/CEO                           Richard S. Moore
                                               Vice President for Business
                                               and Administration

Date: Jan 15, 2002                             Date: Jan 17 2001
     ----------------------                         ----------------------------Exhibit 10.10
                                                                   -------------

                         LILLY BETER CAPITAL GROUP, Ltd.
                          A Prometheus Trust Subsidiary

                                 January 6, 2002

Matthew H. Fleeger, Esq.
CEO Med Solutions, f/k/a
EnviroClean International, Inc.
12750 Merit Drive, Ste. 770
Dallas, Texas 75251

Dear Mr. Fleeger:

         The purpose of this letter is to confirm the  intentions of Lilly Beter
Capital Group, Ltd. (LBCG) concerning  financing for your Company as well as the
impact on financial market conditions resulting from the events of September 11,
2001.

         It is our intention to move forward with a positive and highly feasible
financing package,  which will include an effort to raise (thru a debt offering)
a minimum of $15MM up to a maximum of $20MM in  tradable  low-grade,  high yield
ten-year  bonds.  The interest  rate for this type of debt using a ten-year bond
scenario will fluctuate considerably from 13 1/2% to 15%.

         We understand  thru meetings that Mr. Maxmin  attended in November 2001
(with you) that it is your Company's  intent to use the name of LBCG for an exit
strategy to raise bridge financing.

         If  true,  all  potential  investors  must  be  given  certain  factual
disclosures in advance.  They must be given a copy of this letter, which must be
acknowledged  indicating they know what LBCG's requirements are to make our Bond
fund raising feasible.

         Med Solutions, f/k/a EnviroClean International,  Inc. must be a trading
public company, in good standing,  and in compliance with all applicable filings
for the SEC,  NASD, as well as any state  requirements  that apply to the public
company. It cannot be delinquent with any State or Federal requirements.

         Your Company must have an  acquisition  targeted  along with Letters of
Intent that reflect  revenues and  projections  you gave us last June 2000, that
meet the  requirements  of ERR,  Inc.  and  Simatek.  This  transaction  is also
contingent upon our receiving pro forma financial  statements  establishing that
these acquisitions can support the bond payments and bond expenses of a $15-20MM
bond offering based on a 15% interest rate. The pro forma  financial  statements
we require  include  the  balance  sheet,  cash flow  statement,  and income and
expense.

<PAGE>

         It is  unacceptable  for your  company  to use  LBCG's  name as an exit
strategy  for any  bridge  fund  raising  until you have  selected,  and we have
approved, the targets.

         The Escrow account must be replenished to five hundred thousand dollars
US ($500,000).

         Your Company must  disclose in writing to each  potential  investor and
each  investor must  acknowledge  to LBCG in writing that they have been given a
disclosure  statement  that  describes  the  company's  federal tax  withholding
status.

         Each  investor  must  receive a copy of risk  factors  along  with this
letter.  LBCG suggests that the risk factors be similar to those, which would be
included in the SB or  Prospectus,  and we must approve the list.  Each investor
must acknowledge to LBCG in writing that they have received the risk factors.

         We initially met with you and your Company and discussed  going forward
with this transaction thru a Letter of Intent approximately eighteen months ago.
Many  conditions  have changed since that time.  Market  conditions have taken a
turn; investor attitudes have undergone an evolution; and the economy as a whole
is in a state of uncertainty.  Notwithstanding  these events, we believe in your
Company's  management  and we believe in your ability to  effectively  execute a
well-designed  plan that will take this Company to the heights that we discussed
before.

         We also believe that this plan can be  accomplished  if you are able to
put these  acquisitions  together  successfully,  barring any acts of God,  war,
terrorism and volatile financial market conditions.

         Any  investor,  whether  individual  or  institutional,  as well as any
individual raising capital for your Company must sign a letter stating that they
have  received a copy of this letter and that they fully  understand  that there
are no guarantees  anywhere regarding what market conditions may be from one day
to the next and they  understand what the conditions are for our Company name to
be used in  connection  with any raising of capital.  We must be given a copy of
each signed letter.

         We must meet with each  person  before  they raise any funds to discuss
each of these points.

         The factors  that  initially  motivated  our Company to go forward with
this undertaking are the same factors that will motivate us to go forward today.

<PAGE>

         If this letter meets with your  approval,  please sign below,  date and
then fax me a copy at (713) 863-7602.

         Please do not  hesitate  to call me at (713)  861-7248  if you have any
questions.

                                                      Sincerely yours,

                                                        /s/ Celso B. Suarez, Jr.
                                                      --------------------------
                                                      Celso B. Suarez, Jr.
                                                      Counsel for LBCG
Read and approved

----------------------------
Matthew H. Fleeger

----------------------------
Date<PAGE>

                                     [LOGO]

          NUMBER                                                  SHARES
        ZQ                           ALTUS

              INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE

          THIS CERTIFIES THAT                            SEE REVERSE FOR
                                                        CERTAIN DEFINITIONS

          IS THE OWNER OF

                 FULLY PAID AND NONASSESSABLE SHARES OF COMMON STOCK, $.001 PAR
VALUE PER SHARE, OF
___________________________                        __________________________
___________________________   ALTUS MEDICAL, INC.  __________________________
___________________________                        __________________________

transferable only on the books of the Corporation by the holder hereof in person
or by duly authorized Attorney upon surrender of this certificate properly
endorsed. This certificate is not valid until countersigned by the Transfer
Agent and Registrar.

          WITNESS the facsimile signatures of its duly authorized officers.

Dated:

/s/ Ronald J. Santilli                          /s/ Kevin P. Connors
CHIEF FINANCIAL OFFICER AND         SEAL        PRESIDENT AND CHIEF EXECUTIVE
TREASURER                                       OFFICER

<PAGE>

                               ALTUS MEDICAL, INC.

   THE CORPORATION WILL FURNISH WITHOUT CHARGE TO EACH STOCKHOLDER WHO SO
REQUESTS THE POWERS, DESIGNATIONS, PREFERENCES AND RELATIVE PARTICIPATING,
OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OR SERIES THEREOF AND
THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH PREFERENCES AND/OR
RIGHTS. SUCH REQUEST MUST BE MADE TO THE CORPORATION'S SECRETARY AT THE
PRINCIPAL EXECUTIVE OFFICE OF THE CORPORATION.

   Keep this Certificate in a safe place. If it is lost, stolen or destroyed,
the Corporation will require a bond of indemnity as a condition to the issuance
of a replacement certificate.

         The following abbreviations, when used in the inscription on the face
      of this certificate, shall be construed as though they were written out in
      full according to applicable laws or regulations:

<TABLE>
<S>                                                      <C>
      TEN COM - as tenants in common                     UNIF GIFT MIN ACT- __________ Custodian___________________
      TEN ENT - as tenants by the entireties                                  (Cust)                 (Minor)

      JT TEN -  as joint tenants with right                               under Uniform Gifts to Minors
                of survivorship and not as
                tenants in common                                         Act______________________________________
                                                                                          (State)

                                                         UNIF TRF MIN ACT- __________  Custodian (until age _______)
                                                                             (Cust)

                                                                           ______________ under Uniform Transfers
                                                                              (Minor)

                                                                          to Minors Act ___________________________
                                                                                                  (State)
</TABLE>

     Additional abbreviations may also be used though not in the above list.

For Value Received,___________________________ hereby sell, assign and transfer
unto

PLEASE INSERT SOCIAL SECURITY NUMBER OR OTHER
       IDENTIFYING NUMBER OF ASSIGNEE
---------------------------------------------

---------------------------------------------

________________________________________________________________________________
 (PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE OF ASSIGNEE(S)

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________
Shares represented by the within Certificate, and do hereby irrevocably
constitute and appoint _______________________________________________ Attorney
to transfer the said Shares on the books of the within named Corporation with
full power of substitution in the premises.

Dated ___________________               ________________________________________
                                        NOTICE: THE SIGNATURE TO THIS ASSIGNMENT
In presence of                          MUST CORRESPOND WITH THE NAME AS WRITTEN
                                        UPON THE FACE OF THE CERTIFICATE IN
                                        EVERY PARTICULAR, WITHOUT ALTERATION OR
_________________________               ENLARGEMENT, OR ANY CHANGE WHATEVER.

_________________________

Signature(s) Guaranteed

By______________________________________________________________________________
THE SIGNATURES MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS,
STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN
AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM) PURSUANT TO S.E.C, RULE
17Ad-16

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