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MEDICAL WASTE GENERATOR <br /> FILE COVER SHEET <br /> ACILITY ID#: FA0015510 P/E: 4557 DATE: 02/18/2009 <br /> P OGRAM RECORD#: PR0522754 P/E: DATE: <br /> P/E: DATE: <br /> DRESS: 1776 W MARCH LN 110 CITY: STOCKTON <br /> FACILITY NAME (DBA): MAXIM HEALTHCARE SERVICES <br /> ACILITY PHONE: (2091477-2737 FACILITY FAX: <br /> FACILITY CONTACT: JON BERNSON PHONE: <br /> WNER NAME: MAXIM HEALTHCARE SERVICES IN( CITY: COLUMBIA <br /> WNER ADDRESS: 7080 SAMUEL MORSE DR PHONE: (410) 910-1500 <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#: MWCS New Owner: Create a New Cover Sheet/Change Label of File <br />