Stormwater-

Facility Name: JACOBSON WAREHOUSE CO., LLC

Permit Type: No Exposure Legal Status:

Address: 3311 E. LINCOLN WAY - AMES , IA 50010

County: STORY Field Office: 5 SIC: 4225 Geospatial Information: 452285(X)/4652783(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