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Medical Wastes Accepted from other Facilities: <br /> Medical Wastes accepted for: ® Consolidation ® Treatment <br /> Facility Name Not Applicable <br /> Address <br /> City State Zip <br /> Responsible person <br /> Telephone ( ) <br /> Medical Wastes accepted for: Consolidation E] Treatment <br /> Facility Name Not Applicable <br /> Address <br /> City State Zip <br /> Responsible person <br /> Telephone ( ) <br /> Medical Wastes accepted for: ® Consolidation ® Treatment <br /> Facility Name Not Applicable <br /> Address <br /> City State Zip <br /> Responsible person <br /> Telephone ( ) <br /> 5 <br />