Stormwater-

Facility Name: NORTH IOWA APPLIANCE CENTER

Permit Type: No Exposure Legal Status:

Address: 1600 HWY 18 EAST - ALGONA , IA 50511

County: KOSSUTH Field Office: 2 SIC: 5093 Geospatial Information: 400525(X)/4770280(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: --PERMIT TYPE-- GP #1 GP #2 GP #3 NO EXPOSURE 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