Stormwater-

Facility Name: AMPI MASON CITY DIVISION

Permit Type: No Exposure Certificate Legal Status:

Expiration Date: (no exposure) Address: 1305 19TH ST. SW - MASON CITY , IA 50401

County: CERRO GORDO Field Office: 2 SIC: 2023 Geospatial Information: 480841(X)/4775294(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 - INDUSTRIAL ACTIVITY GP #2 - CONSTRUCTION ACTIVITY GP #3 - INDUSTRIAL ROCK/ASPHALT NO EXPOSURE CERTIFICATE 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