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MEDICAL WASTE GENERATOR <br /> . FILE COVER SHEET <br /> FACILITY ID#: FA0021254 P/E: 4532 DATE: 05/15/2012 <br /> PROGRAM RECORD#: PR0537018 P/E: DATE: <br /> P/E: DATE: <br /> ADDRESS: 702 PORTER AVE#F CITY: STOCKTON <br /> ACILITY NAME (DBA): INNOVATION DENTAL <br /> FACILITY PHONE: (209) 478-9648 FACILITY FAX: <br /> FACILITY CONTACT: DUAN NGUYEN PHONE: (209) 478-9648 <br /> OWNER NAME: DUAN NGUYEN CITY: STOCKTON <br /> OWNER ADDRESS: 702 PORTER AVE #F. STOCKTON PHONE: (408) 644-4308 <br /> Water Service: Large PWS Ift Small PWS Tb 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 />