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R <br /> MEDICAL WASTE GENERATOR <br /> FILE COVER SHEET <br /> FACILITY ID#: FA0018090 P/E: 4530 DATE: 08/30/2007 <br /> PROGRAM RECORD#: PR0526718 P/E: DATE: <br /> P/E: DATE: <br /> ADDRESS: 1610 W KETTLEMAN LN D CITY: LODI <br /> FACILITY NAME (DBA): DAVITA LODI DIALYSIS CENTER <br /> FACILITY PHONE: (209) 334-9888 FACILITY FAX: <br /> FACILITY CONTACT: LICENSURE & CERTIFICATION DEPT PHONE: <br /> OWNER NAME: DAVITA INC CITY: TACOMA <br /> OWNER ADDRESS: 1423 PACIFIC AVE PHONE: <br /> Water Service: ❑ Large PWS Small PWS Domestic Well <br /> Sewer Service: Public Sewer OnSite WWTX OnSite Septic System <br /> Stormwater: Street Drains Street Ditches ❑ OnSite Ponds ,� Other <br /> Eli 00 18 rev 05/2007 <br /> rpL#: MWCS New Owner. Create a New Cover Sheet/Change Label of File <br />