Stormwater- Checklist

Facility Name: EMBRIA HEALTH SCIENCES, LLC

Permit Type: GP #1 Legal Status: Private     File No: 17105   Authorization No: 17105-16881

Expiration Date: 1/1/2030(current) Address: 2105 SE CREEKVIEW DR. - ANKENY , IA 50021

County: POLK Field Office: 5 SIC: 2833 Geospatial Information: 452902(X)/4617338(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