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<br /> MAIL TO DISCHARGE PERMIT APPLICATION — SHORT FORM C
<br /> DEPARTMENT OF NATURAL RESOURCES WISCONSIN POLLUTANT DISCHARGE ELIMINATION SYSTEM (WPDES)
<br /> CHAPTER 147,WIS.STATS.
<br /> WPDES PERMIT SECTION
<br /> BOX 7921 FORM 3400-26 REV. 8-84
<br /> MADISON,WISCONSIN 53707 Appl.No. Date Recd.
<br /> LEAVE BLANK LEAVE BLANK
<br /> PLEASE READ AND FOLLOW CAREFULLY THE INSTRUCTIONS ON THIS APPLICATION FORM.
<br /> PLEASE TYPE OR PRINT REQUESTED INFORMATION,EXCEPT FOR THE SIGNATURE.
<br /> THIS APPLICATION IS TO BE SUBMITTED BY THE OWNER OR OPERATOR OF A FACILITY HAVING ONE OR MORE DISCHARGES TO A SURFACE
<br /> WATER OR TO A SYSTEM FOR THE LAND DISPOSAL OF LIQUID WASTES IN ORDER TO IDENTIFY SUCH DISCHARGES. THIS APPLICATION MUST
<br /> BE SIGNED BY AN OFFICIAL REPRESENTATIVE OF THE FACILITY WHO IS:THE OWNER,THE SOLE PROPRIETOR FOR A SOLE PROPRIETORSHIP,
<br /> A GENERAL PARTNER FOR A PARTNERSHIP,OR AN EXECUTIVE OFFICER OF AT LEAST THE LEVEL OF VICE PRESIDENT FOR A CORPORATION,
<br /> OR AN AUTHORIZED REPRESENTATIVE OF SUCH EXECUTIVE OFFICER HAVING OVERALL RESPONSIBILITY FOR THE OPERATION OF THE
<br /> FACILITY.
<br /> 1. Facility having discharges described in this application. ENTER IN THE SPACES PROV IDED:THE FULL OFFICIAL,LEGAL NAME OF THE FACILIT•T
<br /> THE MAIL AND LOCATION ADDRESSES;THE NAME,TITLE,AND TELEPHONE NUMBER OF AN AGENT AT THIS ADDRESS WHO CAN ANSWER
<br /> QUESTIONS REGARDING THIS APPLICATION;THE NAME AND TITLE OF THE OFFICIAL REPRESENTATIVE SIGNING THIS APPLICATION IF
<br /> HE/SHE IS LOCATED AT THE FACILITY;AND THE NAME OF THE CERTIFIED TREATMENT PLANT OPERATOR IF THERE IS ONE.
<br /> A. NAME OF FACILITY: FTRFR FARMS RFSFARCH R nFVFI npMENT CENTER
<br /> B. MAIL ADDRESS: RR 1 DEERFIELD, WISCONSIN 53531
<br /> (NUMBER AND STREET,BOX,AND/OR ROUTE,CITY,STATE,ZIP CODE)
<br /> C. LOCATION ADDRESS: 2
<br /> 11 Mile N.W. of Deerfield
<br /> (NUMBER AND STREET,CITY,TOWN OR VILLAGE) OR (HIGHWAY OR ROAD WITH DISTANCE
<br /> AND DIRECTION FROM NEAREST CITY)
<br /> Most of N.E. of 4 of Sec. 17, Town of Deerfield, Dane Co. , WI. Except that 14 acres in the
<br /> 11.W. corner. (FOR RURAL FACILITIES ONLY,GIVE LOCATION BY QUARTER QUARTER,SECTION,TOWN& RANGE DESCRIPTION)
<br /> Dane George J. Tyson
<br /> D. COUNTY: CERTIFIED OPERATOR'S NAME
<br /> Robert Swan Fiber Farms Inc. Rep. NUMBER"EZ49-4889
<br /> E. AGENT'S NAME TITLE
<br /> OFFICIAL President.
<br /> F. REPRESENTATIVE'S NAME J. )
<br /> 2. Parent Company or
<br /> ADDRESS,AND THE NAME AND TITLE TLE OFETHE OFFICIAL FREPR REPRESENTATIVE SIGNING THIS APPLICATION IF HE/SHE IS LOCATED ATITHIS MAILING
<br /> ADDRESS.
<br /> A. COMPANY NAME: Fiber Farms Inc.
<br /> B. MAIL ADDRESS: 6400 Monona Drive, Madison, WI. 53716
<br /> (NUMBER AND STREET,BOX AND/OR ROUTE,CITY,STATE,ZIP CODE)
<br /> OFFICIAL President
<br /> C. REPRESENTATIVE'S NAME George J. Tyson TITLE
<br /> 3. SIC code: ——
<br /> (LEAVE BLANK) (ENTER PRINCIPAL 4 DIGIT SIC[STANDARD INDUSTRIAL CLASSIFICATION) NUMBERS USED IN CENSUS
<br /> AND OTHER GOVERNMENT REPORTS) 4
<br /> 4. Number of employes at facility: NORMAL 2 ,MAXIMUM
<br /> 5. SEIReAND WORKS,ENTEtR THE sewer and NAME OF THE IORGAN ORGANIZATION RESPONSIBLE FORS THE OPERATION OF THE WORKS,A WE
<br /> ITS MAIL ADDRESS
<br /> AND THE COUNTY IN WHICH IT IS LOCATED. '^),Q �,(1
<br /> NAME OF N/A COUNTY +� `^'°'-�I --
<br /> ORGANIZATION
<br /> MAIL ADDRESS N/A
<br /> (NUMBER AND STREET,BOX,AND/OR ROUTE,CITY,STATE,ZIP CODE)
<br /> 6. IDENTIFY THE PRINCIPAL PROCESS USED BY,OR SERVICES PERFORMED BY,THE FACILITY.
<br /> Manufacture Fiber Flour
<br /> 7. LIST EITHER THE PRINCIPAL PRODUCTS OF,OR RAW MATERIALS USED BY,THE FACILITY,WHICHEVER WILL BEST INDICATE OR
<br /> REPRESENT THE PRODUCTION CAPACITY OF THE FACILITY.
<br /> PRODUCTS: Edible Fiber
<br /> RAW MATERIALS: Oat, Wheat, Soybean , Rice Hulls and Citrus Skins.
<br /> 8. ENTER THE MAXIMUM QUANTITY OF PRODUCTION OR RAW MATERIAL USE,WHICHEVER IS SELECTED IN ITEM 7,AND SPECIFY CONSECUTIVE UNITS
<br /> USED(POUNDS,TONS,BUSHELS,SQUARE FEET,UNITS OR PIECES,ETC.,AS APPROPRIATE AND CUSTOMARY), IN SEVEN
<br /> 40 Semi-Loads AND IN 440 Semi-Loads ,ALL IN
<br /> DAYS 7 IN A MONTH ,A (20 Tons Each)
<br /> UNITS OF 10 - 20 ton Semi-Loads
<br />
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