Stormwater- Affiliates

Facility Name: BEN KLOCKE - CONSTRUCTION

Permit Type: GP #2 - Construction Activity Legal Status: Private     File No: 14373   Authorization No: 14373-14162

Expiration Date: 8/27/2008 (discontinued) Address: 33215 JADE AVENUE - TEMPLETON , IA 51463

County: CARROLL Field Office: 4 SIC: Geospatial Information: 340468(X)/4637560(Y)

Affiliates   Name Address City State Zip Phone Type BEN KLOCKE 33215 JADE AVENUE TEMPLETON IA 51463 (712)669-3760 Contact BEN KLOCKE 33215 JADE AVENUE TEMPLETON IA 51463 (712)669-3760 Owner 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