Stormwater- Checklist

Facility Name: MERCY MEDICAL CENTER NORTH IOWA

Permit Type: GP #2 Legal Status: Private     File No: 18755   Authorization No: 18755-18531

Expiration Date: 6/30/2012 (discontinued) Address: 1000 4TH ST. SW - MASON CITY , IA 50401

County: CERRO GORDO Field Office: 2 SIC: Geospatial Information: 482443(X)/4777683(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