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HAZARDOUS WASTE GENERATOR <br /> FILE COVER SHEET <br /> FACILITY II)#: �A n P/E: DATE: 04/16/2013 <br /> PROGRAM RECORD#: � S'Si P/E: DATE: <br /> P/E: DATE: <br /> ADDRESS: CITY: l A 1 J�2/•O <br /> FACILITY NAME (DBA): <br /> FACILITY PHONE: FACILITY FAX: <br /> FACILITY CONTACT: PHONE: <br /> OWNER NAME: CITY: <br /> OWNER ADDRESS: 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 O icr <br /> EPA ID#: C�hl L <br /> EH,00 18 rev 05/2007 <br /> rpt#: HWCS New Owner. Create a New Cover Sheet/Change Label of File <br />