Stormwater-

Facility Name: THOMBERT, INC.

Permit Type: No Exposure Legal Status:

Address: 220 INDUSTRIAL DR. - BROOKLYN , IA .

County: POWESHIEK Field Office: 5 SIC: 2821 Geospatial Information: 546514(X)/4622163(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