Stormwater-

Facility Name: DAIRICONCEPTS, LP - ALLERTON SITE

Permit Type: No Exposure Legal Status: Private

Address: 211 N. CENTRAL AVE. - ALLERTON , IA 50008

County: WAYNE Field Office: 5 SIC: 2023 Geospatial Information: 469558(X)/4506248(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