Stormwater - Affiliates

Facility Name: FORT DODGE ANIMAL HEALTH - ANTIVENIN/BLEED LAB

Permit Type: GP #2 - Construction Activity Legal Status: Private File No: 17838 Authorization No: 17838-17604

Expiration Date: 9/1/2010(discontinued) Address: 800 5TH ST. NW - FORT DODGE , IA 50501

County: WEBSTER Field Office: 2 SIC: Geospatial Information: 400430(X)/4708892(Y)

Affiliates

Individual?

Type:*

Name:

Title:

Company Name:

C/O:

Address:

Address 2:

City/State/Zip

E-mail:

Contact Owner

Preferred Method of contact

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