Stormwater- Affiliates

Facility Name: KOSSUTH REGIONAL HEALTH CENTER ADDITION

Permit Type: GP #2 Legal Status: Private     File No: 16692   Authorization No: 16692-16465

Expiration Date: 12/1/2011 (discontinued) Address: 1515 S. PHILLIPS ST. - ALGONA , IA 50511

County: KOSSUTH Field Office: 2 SIC: Geospatial Information: 400463(X)/4767748(Y)

Affiliates   Name Address City State Zip Phone Type MICHAEL KOSLOSKE 3405 SE CROSSROADS DR., SUITE X GRIMES IA 50111 (515)369-4949 Contact KOSSUTH REGIONAL HEALTH CENTER 1515 S. PHILLIPS ST. ALGONA IA 50511 (515)295-7714 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