Stormwater- Affiliates

Facility Name: TRINITY REGIONAL MEDICAL CENTER

Permit Type: GP #2 Legal Status: Private     File No: 13015   Authorization No: 13015-12803

Expiration Date: 2/5/2009 (discontinued) Address: 802 KENYON RD. - FORT DODGE , IA 50501

County: WEBSTER Field Office: 2 SIC: Geospatial Information: 402039(X)/4705711(Y)

Affiliates   Name Address City State Zip Phone Type TRINITY REGIONAL MEDICAL CENTER 802 KENYON RD. FORT DODGE IA 50501 (515)574-6604 Owner MIKE CRAIG 802 KENYON RD. FORT DODGE IA 50501 (515)574-6604 Contact Individual? Type:* --AFFILIATE TYPE-- OWNER OPERATOR CONTACT CERTIFIER Name: Title:   Company Name: C/O:   Address: Address 2: City/State/Zip   --Select-- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY PR OT E-mail:   Contact Owner   NO YES Preferred Method of contact EMAIL US MAIL Business Phone:   Error! Phone Number Format Must Be (XXX)XXX-XXXX Ext: Home Phone:   Error! Phone Number Format Must Be (XXX)XXX-XXXX Fax:   Error! Phone Number Format Must Be (XXX)XXX-XXXX Mobile Phone:   Error! Phone Number Format Must Be (XXX)XXX-XXXX