WI0500033_Application Review Request_20200318

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: March 18, 2020
To: Rick Bolich — Brion Byers
From: Shristi Shrestha, WQROS — Animal Feeding Operations and Groundwater Protection Branch
Telephone: [phone] Fax. [phone] E Mail. [e-mail]
Permit Number: WI0500033
A. Applicant: Donnie R. & Emily Shelton
B. Facility Name:
C. Application:
Permit Type: Geothermal Heating/Cooling Water Return Well
Project Type: Renewal/Name Change
E. Comments/Other Information:
I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed WQROS Staff
Report. —
When you receive this request form, please write your name and dates in the spaces below, make a copy of
this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact person
listed above.
RO-WQROS Reviewer:
COMMENTS:
NOTES:
Date:
FORM: WQROS-ARR ver. 092614 Page 1 of 1