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HAZARDOUS WASTE GENERATOR <br /> FILE COVER SHEET <br /> FACILITY ID#: I (h P/E: DATE: 08/28/2008 <br /> PROGRAM RECORD#: P/E: DATE: <br /> I _ PIE: DATE: <br /> ADDRESS: [�(� ( IV SG,� Vj ah , CITY: Shycl <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 ❑ 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 />