Stormwater- Affiliates

Facility Name: GENESIS MEDICAL CENTER - PARKWAY PROJECT

Permit Type: GP #2 Legal Status: Private     File No: 5667   Authorization No: 5667-5504

Expiration Date: 1/15/2004 (discontinued) Address: 1227 E. RUSHOLME STREET - DAVENPORT , IA 52803

County: SCOTT Field Office: 6 SIC: Geospatial Information: 703725(X)/4601858(Y)

Affiliates   Name Address City State Zip Phone Type MISSMAN STANLEY & ASSOCIATES 2415 - 18TH STREET, SUITE 203 BETTENDORF IA 52722 (319)344-0260 Contact GENESIS MEDICAL CENTER 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 (319)421-3030 Operator GENESIS MEDICAL CENTER 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 (319)421-3030 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