Stormwater- Affiliates

Facility Name: QUIKTRIP 0541 - CONSTRUCTION

Permit Type: GP #2 Legal Status: Private     File No: 26608   Authorization No: 26608-26366

Expiration Date: 5/1/2016 (discontinued) Address: 2428 HUBBELL AVE. - DES MOINES , IA 50317

County: POLK Field Office: 5 SIC: Geospatial Information: 451981(X)/4605986(Y) (Electronic app)

Affiliates   Name Address City State Zip Phone Type MATT BROOKS 5725 FOXRIDGE DR. MISSION KS 66202 (913)905-2059 Contact MATT BROOKS     IA     Certifier QUIKTRIP CORPORATION 5725 FOXRIDGE DR. MISSION KS 66202 (913)905-2059 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