Stormwater- Checklist

Facility Name: TRINITY REGIONAL MEDICAL CENTER

Permit Type: GP #2 Legal Status: Private     File No: 13015   Authorization No: 13015-12803

Expiration Date: 2/5/2009 (discontinued) Address: 802 KENYON RD. - FORT DODGE , IA 50501

County: WEBSTER Field Office: 2 SIC: Geospatial Information: 402039(X)/4705711(Y)

Checklist Checklist Completed. Automatic Update NOI Received Fee Correct Facility Info PPP Developed Location Info PPP Comply Outfall Info Public Notice Received   Contact Info Public Notice Complete   Permit Type Info Signature   Fee Paid File Memo   Fee Memo