Stormwater-

Facility Name: SCHOUTEN PLUMBING AND HEATING, INC.

Permit Type: No Exposure Legal Status:

Address: 1415 S. MAIN AVE. - SIOUX CENTER , IA 51250

County: SIOUX Field Office: 3 SIC: 5093 Geospatial Information: 241035(X)/4773066(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