Stormwater- Affiliates

Facility Name: LOVE'S TRAVEL STOPS AND COUNTRY STORES, INC. - CONSTRUCTION

Permit Type: GP #2 - Construction Activity Legal Status: Private     File No: 30670   Authorization No: 30670-30413

Expiration Date: 4/28/2018 (discontinued) Address: SITE IS LOCATED IN THE NW QUADRANT OF THE INTERSECTION OF GRAYHOUND DR. AND US HWY. 63 - WATERLOO ,

County: BLACK HAWK Field Office: 1 SIC: Geospatial Information: 549231(X)/4701062(Y)

Affiliates   Name Address City State Zip Phone Type HERROLD DEKE WILLIS 4420 JACKSON ST. MARIANNA FL 32446 (850)372-4045 Contact LOVE'S TRAVEL STOPS 10601 N PENNSYLVANIA AVE. OKLAHOMA CITY OK 73120 (405)302-6774 Owner JT ROSS   OKLAHOMA CITY OK 73120 (405)302-6774 Certifier 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