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r - <br />FACILITY ID#: FA0001696 <br />PROGRAM RECORD #: <br />MEDICAL WASTE GENERATOR <br />FILE COVER SHEET <br />PR0450117 <br />RESS: 1601 E HAZELTON AVE <br />PIE: 4530 <br />DATE: <br />P/E: <br />DATE: <br />PIE: <br />DATE: <br />CITY: STOCKTON <br />FACILITY NAME (DBA): SJC PUBLIC HEALTH LAB <br />FACILITY PHONE: (209) 468-3460 FACILITY FAX• <br />FACILITY CONTACT: SJC PUBLIC HEALTH LAB PHONE: <br />2 <br />OWNER NAME: SJC PUBLIC HEALTH CITY: STOCKTON <br />OWNER ADDRESS: 1601 E HAZELTON AVE PHONE: <br />Water Service: <br />Q <br />Large PWS <br />Q <br />Small PWS <br />❑ <br />Domestic Well <br />Sewer Service: <br />❑ <br />Public Sewer <br />❑ <br />OnSite WWTX <br />❑ <br />OnSite Septic System <br />Stormwater: <br />❑ <br />Street Drains <br />Q <br />Street Ditches <br />❑ <br />OnSite Ponds ❑ Other <br />EH 00 18 rev 05/2007 <br />rpt # : MWCS New Owner: Create a New Cover Sheet /Change Label of File <br />