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i <br /> MEDICAL WASTE GENERATOR <br /> FILE COVER SHEET <br /> ACILITY ID#: FA0018092 PIE: 4530 DATE: 01/07/2009 <br /> PROGRAM RECORD#: PR0526720 P/E: DATE: <br /> 3 <br /> P/E: DATE: <br /> ADDRESS: 312 S FAIRMONT AVE A CITY: LODI <br /> CILITY NAME (DBA): DAVITA TOKAY DIALYSIS CENTER <br /> FACILITY PHONE: (209) 369-5418 FACILITY FAX: <br /> FACILITY CONTACT: LICENSURE & CERTIFICATION DEPT PHONE: (800) 477-1916 <br /> OWNER NAME: DAVITA INC CITY: TACOMA <br /> OWNER ADDRESS: 1423 PACIRIC 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 /> EH 00 18 rev 05/2007 <br /> rpt#: MWCS New Owner: Create a New Cover Sheet/Change Label of File <br />