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PERMIT INFORMATION KPDES Storm Water General Permit Number Check here if you are no longer the Operator of the Facility Check here if the Storm Water Discharge is Being Terminated II. FACILITY OPERATOR INFORMATION Name Address City/ State/Zip Code Telephone Number III. FACILITY/SITE LOCATION INFORMATION Is this part of a larger common plan of development yes no Name of Main Contractor Lot Number of Address of Lot s City/County/State/Zip Code Certification I certify under penalty of law that all ...

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