Stormwater - No Exposure Certification

Facility Name: CRESCENT PARK CORP.

Permit Type: No Exposure Certificate Legal Status:

Expiration Date: (no exposure) Address: 904 - 12TH STREET NW - MASON CITY , IA 50401

County: CERRO GORDO Field Office: 2 SIC: 4222 Geospatial Information: 482456(X)/4779263(Y)

No Exposure Certification



Application Date:	MM/DD/YYYY
Previously covered under a NPDES Storm Water permit?
If yes, enter permit number:
Certification Signed?
Permit Type:
SIC:
Notes:
Eligibility Confirmed Date:	MM/DD/YYYY
Not Eligible For Storm Water Exclusion Date:	MM/DD/YYYY
Application For Storm Water Exclusion Approved Date:	MM/DD/YYYY
Expiration Date Of Exclusion:	MM/DD/YYYY