Stormwater-

Facility Name: MI-T-M BUILDING H

Permit Type: No Exposure Legal Status:

Address: 8650 ENTERPRISE DRIVE - PEOSTA , IA 52068

County: DUBUQUE Field Office: 1 SIC: 3569 Geospatial Information: 673475(X)/4703411(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