Stormwater- Affiliates

Facility Name: NEW KLEIN CENTER - NURSING CARE FACILITY

Permit Type: GP #2 - Construction Activity Legal Status: Private     File No: 20172   Authorization No: 20172-19958

Expiration Date: 5/23/2014 (discontinued) Address: 1221 S. GEAR AVE. - WEST BURLINGTON , IA 52655-1654

County: DES MOINES Field Office: 6 SIC: Geospatial Information: 653921(X)/4519057(Y)

Affiliates   Name Address City State Zip Phone Type BRYAN C. BROSS 610 N. 4TH ST., SUITE 100 BURLINGTON IA 52601 (319)753-1636 Contact GREAT RIVER MEDICAL CENTER 1221 S. GEAR AVE. WEST BURLINGTON IA 52655-1654 (319)768-3807 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