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MEDICAL WASTE PROGRAM ` l�Jl <br /> l <br /> Business Name �� 5� �� Q�� Phone <br /> Business Address— <br /> City Zip <br /> ontact Person Phone <br /> Owner Phone <br /> Owner Address <br /> ity Zip <br /> rogram Element Code <br /> Record ID # <br /> nsite Treatment? Y N (Circle) 4� if Yes, Treatment Unit Type <br /> QHE? Y N (Circle) <br /> MWMP in EHD file? Y N (circle) <br />