Many agencies at the federal, state, watershed, and local levels have jurisdiction over surface and ground waters in Minnesota. These jurisdictions can vary and overlap. Multiple agencies involved in managing the same jurisdictional water lead to complex regulations and permitting programs. This complexity is documented in the 2002 report by the Minnesota Planning Department titled: Charting a Course for the Future: Report of the State Water Program Reorganization Project.
This page focuses solely on those programs and permits that are specifically tied to stormwater management, though many other programs may exist that have an indirect stormwater connection. Examples include federal and state hazardous waste management, aboveground and underground storage tanks, solid waste management, oil handling and spill prevention, pesticide management, and facility planning and construction. (See also File:Issue paper C - stormwater regulatory framework.pdf)
This page focuses primarily on description/interpretation of programs and permits at the federal and state levels. Most of the decisions about development and land use however are made at the local level. It is also at the local level that the effects of runoff problems become most apparent and the responsibility for implementing and maintaining the stormwater infrastructure and stormwater management resides. Because of this, many of the federal and state regulatory programs have a large impact on stormwater management responsibilities at the local level. Counties, watershed organizations, regional agencies (e.g. Metropolitan Council), municipalities, and townships are all examples of local government groups that may have responsibility for stormwater management.
The implementation vehicle for many local stormwater management programs is through local ordinances. Stormwater management activities may be addressed through specific stormwater ordinances, zoning ordinances or development ordinances and may contain requirements for water quantity, water quality, erosion and sediment control, nonpoint source pollution control, channel protection, and natural area protection.
While the Manual has no regulatory authority in and of itself, it seeks to provide a sound technical basis for stormwater management design and implementation. This can be coordinated on a statewide level through existing laws and regulations. The following table provides a summary of regulatory authorities for some common stormwater management activities. It outlines the agencies with permitting or review authority and those with the ability to set standards or provide enforcement for those programs.
Summary of regulatory authorities for some federal, state and local agencies and government units.
Link to this table
|Erosion and sediment control||Conditional||Full||Review||Full|
|Lake, stream, river protection||Conditional||Full||Review||Full||Full||Review||review||Conditional|
|Surface water quality protection||Conditional||Full||Conditional||Review||Review||Conditional|
|Construction stormwater discharge||Conditional||Full||Conditional||Review||Conditional|
|Municipal stormwater discharge||Conditional||Full||Review||Conditional|
|Industrial stormwater discharge||Conditional||Full||Conditional||Conditional|
|Agricultural stormwater discharge||Conditional||Full||Review||Conditional|
aDepending upon location in the state, the local jurisdictions may be administered at the county, watershed organization (if one exists), city/township/village, or tribal level, or a combination of these. contact the local zoning authority for more information on local regulations.
USEPA = United States Environmental Protection Agency, USACE = United States Army Corp of Engineers, FEMA = Federal Emergency Management Agency, MPCA = Minnesota Pollution Control Agency, DNR = Minnesota Department of Natural Resources, BWSR = Board of Water and Soil Resources, MDH = Minnesota Department of Health
Note: FEMA, BWSR and MDH have no enforcement authority for any of these action classes. Met Council has enforcement authority for industrial stormwater discharges. The remaining agencies have enforcement authority.
The following programs are implemented at the federal level.
This program applies to all waters of the United States, including lakes, rivers, ponds, streams, and wetlands. The Section 404 program regulates the discharge of dredged or fill material into waters of the U.S.
There are several categories of permits and approvals, including
An individual permit is required if the proposed work does not meet the requirements of one of the following specific general permits or letter of permission.
The Section 10 program applies to all Navigable Waters of the U.S. Navigable Water designation is based on past, present or potential use for transportation or interstate commerce. The Section 10 program regulates any work in, over or under a Navigable Water of the U.S or work that affects the course, location, condition or capacity of such waters.
There are several categories of permits and approvals, including
An individual permit is required if the proposed work does not meet the requirements of one of the following specific general permits or letter of permission
This program applies to shallow disposal systems that are used to place a variety of fluids, including stormwater, below the land surface. Class V injection wells are defined as any bored, drilled, driven shaft, or dug hole that is deeper than it is wide; any improved sinkhole; or any subsurface fluid distribution system.
The purpose of the program is to prevent the contamination of any underground sources of drinking water. Inventory information must be submitted for any existing Class V injection wells and before installation of new Class V injection wells. However, a permit is not required if it is determined that the well does not endanger underground sources of drinking water.
The program has two requirements:
This is a joint federal, state, and local program, overseen by the National Park Service which provides coordination for 72 miles of the Mississippi River, four miles of the Minnesota River, and 54,000 acres of adjacent corridor lands. The MNRRA Comprehensive Management Plan adopts and incorporates by reference the state Critical Area Program, Shoreland Management Program, and other applicable state and regional land use management programs that implement the plan’s visions.
The following programs are implemented at the state level.
The Stormwater Program is a comprehensive state stormwater program based on the Federal NPDES program and administered by the MPCA with oversight by the USEPA. The program is based on federal Clean Water Act requirements for addressing polluted stormwater runoff. Stormwater disposal is regulated nationally through the National Pollutant Discharge Elimination System (NPDES) and Minnesota regulates the disposal of stormwater through the State Disposal System (SDS) MPCA issues combined NPDES/SDS permits.
A 1987 amendment to the Federal Clean Water Act required implementation of a two-phase comprehensive national program to address stormwater runoff. Phase I regulated large construction sites, 11 categories of industrial facilities, and major metropolitan municipal separate storm sewer systems (MS4s), including Minneapolis and St. Paul. Phase II includes smaller construction sites, municipally owned or operated industrial activity, and many more municipalities.
Stormwater permits require permittees to control polluted discharges. Regulated parties must develop stormwater pollution prevention plans (or stormwater pollution prevention programs, for MS4s) to address their stormwater discharges. Each regulated party determines the appropriate best management practices (BMPs) to minimize pollution for their specific site. The three permit types - construction, industrial, and MS4 - have distinct requirements and some regulated parties may require more than one permit.
There are two types of NPDES/SDS permits: general permits and individual permits. If work meets the requirements of a specific general permit, an individual permit is not required. Currently there are three categories for stormwater permitting as follows:
The feedlot program regulates the collection, transportation, storage, processing and disposal of animal manure and livestock processing activities, and provides assistance to counties and the livestock industry. The rules apply to all aspects of livestock production areas including the location, design, construction, operation and management of feedlots, feed storage, stormwater runoff, and manure handling facilities.
Section 319 of the Clean Water Act requires each state to address nonpoint pollution by developing nonpoint source assessment reports that identify nonpoint source pollution problems and the nonpoint sources responsible for the water quality problems. States also adopt management programs to control nonpoint source pollution and then implement the management programs. States, Territories, and Indian Tribes can receive Section 319 grant money which supports a wide variety of activities including technical assistance, financial assistance, education, training, technology transfer, demonstration projects, and monitoring to assess the success of specific nonpoint source implementation projects
Minnesota became part of the national Coastal Management Program after receiving federal approval in July 1999Minnesota’s Lake Superior Coastal Nonpoint Pollution Control Program is designed to reduce nonpoint pollution in the Lake Superior Basin
This program’s mission is to protect the public health by ensuring a safe and adequate supply of drinking water at all public water systems (community and non-community drinking water systems)The program reviews plans for water system improvements, conducts on-site inspections and sanitary surveys, provides training and technical assistance, ensures that water systems are tested for contaminants, and takes action against water systems not meeting standards.
This program applies to drinking water and its sources, which includes rivers, lakes, reservoirs, springs, and ground water wells. The Source Water Protection Program’s purpose is to help prevent contaminants from entering public drinking water sources. There are three different classifications of public water systems: communities, transient noncommunities, and nontransient noncommunities. For groundwater supply areas, each of the public water system categories maintains an inner wellhead management zone, which is a 200-foot radius around wellsIn addition, communities and nontransient noncommunities must also identify capture zones for their wells (wellhead protection areas) and create a formal wellhead protection plan
The Source Water Protection Program consists of three primary parts:
The Minnesota Department of Health is currently developing guidelines for protection plans.
This program, begun in 1937, regulates water development activities below the ordinary high water level (OHWL) in public waters. The Public Waters Work Permit Program applies to those lakes, wetlands, and streams identified on DNR Public Water Inventory maps. Proposed projects affecting the course, current, or cross-section of these water bodies may require a Public Waters Work Permit from the DNR
There are two types of Public Waters Work Permits: general permits and individual permits. If work proposed in public waters or public waters wetlands meets the requirements of a specific general permit, an individual permit is not required. Currently there are five categories of general permits as follows:
An individual permit is required if the proposed work does not meet the requirements of a specific general permit. There are also deregulated activities for which no permit is required.
This program was created in response to legislation requiring DNR to balance competing management objectives that include both development and protection of Minnesota’s water resources. The Water Appropriations Permit Program applies to all users withdrawing more than 10,000 gallons of water per day or 1 million gallons per year. Proposed projects withdrawing this amount of water or more may require a Water Appropriations Permit from the DNR
There are several types of water appropriations permits including general permits and individual permits for both irrigation and non-irrigation purposes. Several exemptions apply for domestic uses serving less than 25 people, test pumping of a groundwater source, reuse of water already authorized by a permit, and for certain agricultural drainage systems. If appropriations meet the requirements for one of the general permits then an individual permit is not required.
Currently there are two categories of general permits:
If the proposed appropriation does not meet the requirements of a specific general permit or is not exempt, an individual permit is required.
Calcareous fens are classified as outstanding resource value waters (ORVWs) and are protected under the restricted discharge provisions of the MPCA water quality standards in Minnesota Rule 7050.0180 Subp6In addition, calcareous fen protections were also put in place in 1991 with the passing of the Wetland Conservation Act and regulate activities that may alter or degrade calcareous fens. Calcareous fens are the rarest wetland community in Minnesota and may not be drained or filled or otherwise altered or degraded except as provided for in a management plan approved by the commissioner.
This program was created in 1978 in response to the federal Dam Safety Act and regulates the repair, operation, design, construction, and removal of public and private dams. The program sets minimum standards for dams regarding safety, design, construction, and operation and it classifies dams into three dam hazard classes. Proposed projects for construction, alteration, repair, removal or transfer of ownership of a regulated dam may require a Public Waters Work Permit
Public Waters Work Permit
The Mississippi River Critical Area Program is a joint local and state program that provides coordinated planning and management for 72 miles of the Mississippi River, four miles of the Minnesota River, and 54,000 acres of adjacent corridor lands
Six rivers in Minnesota have segments, which are designated as wild, scenic, or recreational under the state program in addition to the federally designated lower St. Croix River. These seven rivers are also designated as Outstanding Resource Value Waters (ORVWs) in Minnesota. Each of the seven designated river segments in Minnesota has a management plan, which outlines the rules and goals for that waterway. These rules work together with local zoning ordinances to protect the rivers from pollution, erosion, over-development, and degradation factors, which undermine the wild, scenic, and recreational qualities for which they were designated
The Board of Water and Soil Resources (BWSR) oversees the adoption and implementation of comprehensive local water management plans, which are voluntary plans created by counties outside the seven-county metropolitan areaThe Act, passed in 1985 encourages counties outside the metropolitan area to protect water resources through the adoption and implementation of local water management plans that are based on local priorities.
After local, regional, and agency review, plans are approved by the Board of Water and Soil Resources. The WMO/WD/JPO then formally adopts the plan and requires each city or township within the WMO/WD/JPO to create and implement their own local water management plan consistent with the WMO/WD plan. Updates are required every 5-10 years.
Many programs are administered at the local level. Some of those are discussed below.
This program, begun in 1991, regulates drainage, fill, or excavation of wetlands in the state. Proposed projects are required to demonstrate through sequencing requirements that the project first seeks to avoid disturbing the wetland; second try to minimize any impact on the wetland; and finally, when impact is unavoidable, replaces any lost wetland acres, functions, and values. Certain wetland activities are exempt from the act, allowing projects with minimal impact or projects located on land where certain pre-established land uses are present to proceed without regulation
There are two categories for WCA permits:
Projects disturbing wetlands may also require permits or approvals from the Department of Natural Resources, U.S Army Corps of Engineers, and Minnesota Pollution Control Agency. A joint application form has been developed that may be used for application to all of these agencies.
This program regulates and monitors industrial discharges into the Metropolitan Disposal System (public sanitary sewer system) to ensure compliance with local and federal regulations. Industrial users discharging wastewater into public sewers are required to apply for an industrial waste permit
There are three categories for industrial waste permits:
Below is a summary
Local units of government for flood prone communities are required to adopt the DNR minimum standards, or stricter, for floodplain management into their ordinances and permit programs. They are also required to enroll and maintain eligibility in the DNR administered National Flood Insurance Program (NFIP), to protect new development and modifications to existing development from flood damages when locating in a flood prone area cannot be avoided.
Table 5.3 is a permitting worksheet that is designed to aid the user in determining which permits they may need for a specific project and which agencies to contact for more information. This worksheet should not be viewed as a definitive list but rather as a resource to point the user in the right direction. This worksheet is provided as a means of organization and information gathering. Applicants should always check with their local zoning authority for more information on local requirements
If a project is in, near, or draining to a Special Water then additional permit conditions designed to preserve and protect the quality and character of these unique waters will apply. Additional regulatory information that may be useful is located on various websites (see References) and includes the following.
Summary of federal and state stormwater related permits.
Link to this table
|Permit Title||Regulatory Agenc||Enforcement Authority||Implementation Authority||Applicability||Stormwater Regulated Activities|
|NPDES/SDS Construction Site Permit (Phase II)||MPCA||MPCA USEPA||USEPA - Clean Water Act M.S. 115.01- 115.09 Mn. Rules 7090||Applies to all construction disturbing one or more acres of land, areas less than one acre if that activity is part of a “larger common plan of development or sale” that is greater than one acre, and MPCA designated construction activities disturbing less than one acre that have the potential for contribution to a violation of a water quality standard or for significant contribution of pollutants to water resources||Stormwater discharge associated with road building, landscaping, clearing, grading, excavation, and construction of homes, office buildings, industrial parks, landfills and airports.|
|NPDES/SDS Municipal Separate Storm Sewer System Permit (Phase II)||MPCA||MPCA USEPA||USEPA - Clean Water Act M.S. 115.01- 115.09 Mn. Rules 7001 and 7090||Applies to municipal separate storm sewer systems located in state and federal designated areas.||On going site management and maintenance activities. Site management must include at a minimum the Six Minimum Control Measures: 1. public education and outreach, 2. public participation and involvement, 3. illicit discharge detection and elimination, 4. construction site storm water runoff control, 5. post construction storm water management, and 6. pollution prevention / good house keeping.|
|NPDES/SDS Industrial Site Permit (Phase II)||MPCA||MPCA USEPA||USEPA - Clean Water Act M.S. 115.01- 115.09 Mn. Rules 7001 and 7090||Applies to public (municipal) and private operators of industrial facilities included in one of the 11 categories of industrial activity defined in the federal regulations by an industry’s Standard Industrial Classification (SIC) code or a narrative description of the activity found at the industrial site are required to apply for a permit||On going site management and maintenance activities. Site management may include BMPs such as oil and grease separators, designated wash out locations, site sweeping, and storing materials indoors.|
|NPDES/SDS Feedlot Permit||MPCA||MPCA USEPA||USEPA - Clean Water Act M.S.115.076 and 116.07 Mn. Rules 7001, 7020, 7050, and 7060||Applies to owners and operators of feedlots capable of holding 1,000 animal units or more or Concentrated Animal Feeding Operations (CAFOs) meeting criteria in 40 CFR § 122.23(b) (4).||Stormwater discharge associated site location and expansion activities; construction activities; manure application, storage (stockpiling) location, and management; phosphorus management, pollutions prohibitions; and process wastewater and milk house wastes.|
|401 Water Quality Certification||MPCA||MPCA USEPA||USEPA – Clean Water Act (33 U.S.C. 1341) M.S. 115.03 Mn. Rules 7001||Applies to all activities requiring a federal permit that may have discharge to state waters.||Water quality impacts that may be generated from the structure, siting, or runoff management.|
|Section 404 Permit||USACOE||USACOE USEPA||USEPA - Clean Water Act Section 404 (33 U.S.C. 1344)||Applies to territorial seas; all navigable waters and adjacent wetlands; tributaries to navigable waters and adjacent wetlands; Interstate waters and adjacent wetlands; and all waters not identified above in which the destruction or degradation could affect interstate commerce||Discharge of dredged or fill material into waters of the United States.|
|Section 10 Rivers and Harbors Act Permit||USACOE||USACOE||Rivers and Harbors Act Section 10||Applies to all Navigable Waters of the U.S. Navigable Water designation is based on past, present or potential use for transportation or interstate commerce.||Any work in, over or under a Navigable Water of the U.S or work that affects the course, location, condition or capacity of such waters.|
|Class V Injection Well Inventory and Permit||USEPA||USEPA||Safe Drinking Water Act||Applies to all potential underground sources of drinking water.||Installation, operation, or abandonment of shallow disposal systems that are used to place stormwater below the land surface through a shaft or hole that is deeper than it is wide.|
|Public Waters Work Permit||DNR||DNR||M.S. 103G.245 Mn. Rules 6115||Development activities below the ordinary high water level (OHWL) in public waters and public waters wetlands||Filling, excavation, shore protection, bridges and culverts, structures, docks, marinas, water level controls, dredging, and dams.|
|Water Appropriations Permit||DNR||DNR||103G.255 Mn. Rules 6115.0600||Regulates surface and ground water appropriations and use of water||Construction dewatering permits (erosion control and discharge conditions).|
|Calcareous Fen Management Plan||DNR||DNR MPCA||103G.223 Mn. Rules 8420.1010||Regulated drain, fill, otherwise alter or degrade calcareous fen||Discharges that affect the quantity, quality, or chemistry of waters supporting the fen.|
|Utility Crossing License||DNR||DNR||M.S. 84 Mn Rules 6135||Applies to utility crossing of any state land or public waters.||Discharges or adverse effect to the water resource resulting from passage of any utility over, under, or across state land or public waters.|
|Water/Wetlands Project Permit (WCA)||LGU (as designated in WCA)*||DNR||Wetland Conservation Act M.S. 103G Mn. Rules 8420||Applies to all jurisdictional wetlands.||Draining, filling, and in some cases excavation, degradation of water quality due to untreated stormwater runoff.|
|Industrial Discharge Permit||Met Council (Twin Cities Area Only)||MPCA USEPA||Mn. Rules 473||Applies to industrial users of the Metropolitan Disposal System (public sanitary sewers)||Stormwater discharge, leachate, and groundwater where there is no prudent or feasible disposal alternatives.|
|Drainage Permit or Permission||Drainage Authority||Drainage Authority LGU*||M.S. 103D M.S. 103E||Applies to the public drainage system.||Introduction of stormwater into the system, conveyance of stormwater through the system, and discharge of stormwater from the system.|
|Other Local Permits||LGUs*||LGU* DNR MPCA||Various||Applies to any additional local regulations which may include resources in the above categories, shoreland management, floodplain management, lake improvement districts, landfills, wastewater, sand and gravel operations, hot mixing, dewatering, TMDLs, etc.||Various.|
|*C.F.R. - Code of Federal Regulations
Link to this table
|Step 1: Determine if your project entails a regulated activity:|
|Is the project:||Yes||No||Not sure?||Primary Agency to Contact||Related Permits You May Need|
|disturbing > 1 acre?||Check project plans||MPCA, MS4||NPDES/SDS Construction Permit|
|dewatering?||Check project plans||DNR||Water Appropriations Permit|
|appropriating water?||Check project plans||DNR||Water Appropriations Permit|
|an industrial discharge?||Check project plans||MPCA Met Council||NPDES/SDS Industrial Permit Industrial Waste Disposal Permit|
|a feedlot operation?||Check project plans||MPCA MDA||NPDES/SDS Feedlot Permit|
|discharging to Special Waters?||Check Special Waters list||MPCA||NPDES/SDS Permits|
|discharging to surface waters?||Check project plans||MPCA DNR||NPDES/SDS Permit Water Appropriations Permit|
|disposing/injecting stormwater into the shallow subsurface?||Check project plans||USEPA||Class V Injection Well Inventory Class V Injection Well Permit|
|draining wetland?||Check NWI Check wetland delineation||USACE DNR MPCA BWSR, LGU|
|filling wetland?||Check NWI Check wetland delineation||USACE DNR MPCA WSR, LGU|
|excavating wetland?||Check NWI Check wetland delineation||USACE DNR MPCA WSR, LGU|
|innundating wetland?||Check NWI Check wetland delineation||USACE DNR MPCA WSR, LGU|
|affecting a calcareous fen?||Check calcareous fens list||X||X|
|working below the ordinary high water level or in a Public Water?||Check OHWL Check PWI||DNR||Public Waters Permit|
|a utility crossing (e.g. pipe, transmission line, etc.)?||Check project plans||DNR, public owner of land||Utility Crossing License, State/Public Landowner Permission|
|Step 2: Determine the receiving water|
|Is the project area is in, near, or draining directly to:||Yes||No||Not Sure?||Primary Agency to Contact||Considerations and Related Permits You May Need|
|a trout lake or lake trout lake?||Check trout lakes||DNR||Special Permit Conditions Apply|
|DNR public waters?||Check PWI||DNR||Public Waters permit|
|a water of the US?||Check Waters of US||USACE||Section 404 or Section 10 Permit and Section 401 Water Quality Certification|
|a trout stream?||Check trout streams||DNR||Special Permit Conditions Apply|
|a wild, scenic, or recreational river?||Check WSR Rivers||DNR||Special Permit Conditions Apply|
|the Upper Mississippi River?||Check Special Waters||DNR||Special Permit Conditions Apply|
|a public drainage ditch?||Contact Drainage Authority||Drainage Authority||Drainage permit/permission|
|wetland?||Check NWI Check wetland delineation||BWSR, LGU||WCA Permit, Section 404 Permit, Public Waters Permit, and/or Section 401 Water Quality Certification|
|DNR public waters wetlands?||Check PWI||DNR||WCA Permit, Section 404 Permit, Public Waters Permit, and/or Section 401 Water Quality Certification|
|a calcareous fen?||Check Calcareous Fens list||DNR, MPCA||Approved calcareous fen management plan and individual NPDES/SDS permit|
|an impaired water or TMDL listed water?||Check 303d list||MPCA||Special Permit Conditions Apply|
|outstanding resource value waters (ORVWs)?||Check ORVWs||MPCA||Special Permit Conditions Apply|
|Step 3: Determine if your project area is in, near, or draining to special areas:|
|Is the project area in, near, or draining directly to:||Yes||No||Not Sure?||Primary Agency to Contact||Considerations and Related Permits You May Need|
|MS4?||Check with MS4 (City, Watershed, Mn/DOT)||MPCA, LGU||NPDES/SDS MS4 Permit|
|a construction site?||Check with LGU||MPCA, LGU||NPDES/SDS Construction Permit|
|an industrial site?||Check with LGU||MPCA Met Council||NPDES/SDS Industrial Permit or Industrial Waste Disposal Permit|
|a feedlot operation?||Check with LGU||MPCA||NPDES/SDS Feedlot Permit|
|a coastal zone (Lake Superior)?||Check Coastal Zone||DNR||Special Permit Conditions Apply|
|the Mississippi River Critical Area (MRCA)?||Check MRCA||DNR||Special Permit Conditions Apply|
|a shoreland district?||Check with LGU||LGU||Special Permit Conditions Apply|
|a floodplain, floodway, or flood zone?||Check FEMA maps||LGU||Special Permit Conditions Apply|
|a wilderness area?||Check Wilderness Areas||NPS, USFS, BLM, USFWS||Special Permit Conditions Apply|
|a scientific or natural area?||Check SNAs||DNR||Special Permit Conditions Apply|
|a lake improvement district?||Check with LGU||LGU||Special Permit Conditions Apply|
|a dewatering site?||Check project plans||DNR||Water Appropriations Permit|
|a watershed district or water management organization?||Check WD/WMOs||WD/WMO,BWSR||Watershed Permits|
|an Indian Reservation?||Check Reservations||Tribal government||Tribal Permits|
|federally protected land?||Check with LGU||NPS, USFS, BLM, USFWS||Special Permit Conditions Apply|
|a source water protection area?||Check with LGU||LGU, MDH||Special Permit Conditions Apply|
|a drinking water protection area?||Check with LGU||LGU, MDH||Special Permit Conditions Apply|
|a karst area?||Check Karst||DNR, LGU||Special Permit Conditions Apply|
|a wellhead protection area?||Check with LGU||LGU, MDH||Special Permit Conditions Apply|
|Step 4: Compile a list of agencies to consult and permits you may need (from lines marked “yes” above):|
|Agency to consult:||Permits which may be required:|
|Step 5: Consult your local zoning authority and watershed organization for more information on local regulations/requirements/permits|
|Local Zoning Authority:||Local Watershed Organization:|
|Contact Name:||Contact Name:|
|City, State, Zip:||City, State, Zip:|