Stormwater- Checklist

Facility Name: STEW HANSEN'S DODGE CITY

Permit Type: GP #2 Legal Status: Private     File No: 3568   Authorization No: 3568-3407

Expiration Date: 5/11/1999 (discontinued) Address: 12103 HICKMAN RD (HI-WAY 6) - URBANDALE , IA 50322

County: POLK Field Office: 5 SIC: Geospatial Information: 434682(X)/4607335(Y)

Checklist 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 RECEIVED $250.00 FEE 5/12/98; C/V REFUND $100.00 FOR OVERPAYMENT ISSUED 6/05/98.