Stormwater-

Facility Name: ROLAND TRANSPORT, INC - HEART OF IOWA COOP (SHOP)

Permit Type: No Exposure Legal Status:

Address: 229 EAST ASH STREET - ROLAND , IA 50236

County: STORY Field Office: 5 SIC: 4213 Geospatial Information: 458936(X)/4668770(Y)

No Exposure Certification Application Date: MM/DD/YYYY Previously covered under a NPDES Storm Water permit? If yes, enter permit number: Certification Signed? Permit Type: --PERMIT TYPE-- GP #1 GP #2 GP #3 NO EXPOSURE SIC: Notes: Eligibility Confirmed Date: MM/DD/YYYY Not Eligible For Storm Water Exclusion Date: MM/DD/YYYY Application For Storm Water Exclusion Approved Date: MM/DD/YYYY Expiration Date Of Exclusion: MM/DD/YYYY