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�y- <br /> MEDICAL WASTE PROGRAM <br /> TA <br /> Business Name L.4 fe, bneo- /q of 14/�j Lam- Phone a 16 "SFI- (p Si p <br /> Business Address ' (9 a'jc -rr'o- e:>to d -4e,Z©© <br /> Ci —:rx-d�le lL Q- ce" 0� Zi <br /> tY P <br /> ontact Person Phone <br /> wner Phone <br /> Owner Address <br /> ity Zip <br /> Program Element Code <br /> Record 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 />