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1 <br /> MEDICAL WASTE PROGRAM <br /> Business Name QdG�hG N1 O��ii CLQ Phon jj�co� <br /> Business Address 1 �'� �• ��� /`�' <br /> ity TMCAJ zip <br /> Contact Person Phone <br /> Owner Phone <br /> Owner Address <br /> Ci Zip <br /> Program Element Code <br /> ecord ID # <br /> Onsite Treatment? Y N (Circle) if Yes,Treatment Unit Type <br /> LQHE? Y N (Circle) <br /> MWMP in EHD file? Y N (circle) <br /> i <br />