Stormwater- Checklist

Facility Name: PELLA REGIONAL HEALTH CENTER

Permit Type: GP #2 Legal Status: Private     File No: 12904   Authorization No: 12904-12697

Expiration Date: 12/19/2010 (discontinued) Address: 404 JEFFERSON ST. - PELLA , IA 50219

County: MARION Field Office: 5 SIC: Geospatial Information: 507139(X)/4584389(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