Stormwater- Checklist

Facility Name: MERCY MEDICAL CENTER W CAMPUS SAN SEWER IMPRV

Permit Type: GP #2 Legal Status: Private     File No: 8749   Authorization No: 8749-8555

Expiration Date: 2/16/2006 (discontinued) Address: 910 N. EISENHOWER AVENUE - MASON CITY , IA 50401

County: CERRO GORDO Field Office: 2 SIC: Geospatial Information: 478789(X)/4778531(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