Stormwater-

Facility Name: RATHBUN LAKE MARINA

Permit Type: No Exposure Legal Status: Private

Address: 21646 MARINA PL. - MORAVIA , IA 52571

County: APPANOOSE Field Office: 5 SIC: 4493 Geospatial Information: 510693(X)/4521556(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