Stormwater- Affiliates

Facility Name: ORANGE CITY HEALTH SYSTEM REPLACEMENT CAMPUS

Permit Type: GP #2 Legal Status: Private     File No: 7814   Authorization No: 7814-7615

Expiration Date: 6/9/2007 (discontinued) Address: INTERSECTION OF HIGHWAY 10 AND LINCOLN PLACE - ORANGE CITY , IA 51041

County: SIOUX Field Office: 3 SIC: Geospatial Information: 252013(X)/4764609(Y)

Affiliates   Name Address City State Zip Phone Type ORANGE CITY HEALTH SYSTEM 400 CENTRAL AVENUE NW ORANGE CITY IA 51041 (712)737-5265 Owner MARK POTTEBAUM 1000 LINCOLN PLACE SE ORANGE CITY IA 51041 (712)737-5265 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