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MEDICAL WASTE GENERATOR <br /> FILE COVER SHEET <br /> FACILITY ID#: FA0020666 P/E: 4557 DATE: 01/11/2011 <br /> PROGRAM RECORD#: PR0535892 P/E: DATE: <br /> P/E: DATE: <br /> ADDRESS: 4368 SPYRES WAY CITY: MODES <br /> FACILITY NAME (DBA): COMMUNITY HOSPICE INC <br /> FACILITY PHONE: (209) 578-6345 FACILITY FAX: <br /> t <br /> CILITY CONTACT: CARLENE BETTENCOURT PHONE: <br /> I <br /> OWNER NAME: COMMUNITY HOSPICE INC CITY: MODESTO <br /> OWNER ADDRESS: 4368 SPYRES WAY PHONE: (209) 578-6345 <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 <br /> #: MWCS New Owner: Create a New Cover Sheet/Change Label of File <br />