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HAZARDOUS WASTE GENERATOR <br /> FILE COVER SHEET <br /> r � P/E: 9a9-6 DATE: 05/17/2012 <br /> FACILITY ID#: <br /> PROGRAM RECORD#: U-7 269 P/E: DATE: <br /> PIE: DATE: <br /> ADDRESS: Lcsu� V "h V) . CITY: { �i <br /> FACILITY NAME (DBA): q <br /> FACILITY PHONE: (� �3 l 0014, FACILITY FAX: <br /> FACILITY CONTACT: VJU� PHONE: <br /> OWNER NAME: /UI��� V+W CITY: Mi �e- <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 ❑ Other <br /> EPA ID#: � <br /> EH 00 18 rev 05/2007 <br /> rpt#: HWCS New Owner: Create a New Cover Sheet/Change Label of File <br />