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:? Minnesota <br />CoMinnesota Feedlot <br />Controltrol Agency <br />t. Pauli MN 55155-4194LafayetteRoadNorth <br />S(Nol l-NPDES) Inspection Checklist <br />St. <br />NPDES/SDS Feedlot Program <br />National Pollutant Discharge Elimination System/ <br />State Disposal System (NPDES/SDS) <br />Doc Type: Inspection (wq-f3-45e) <br />Key at the end of the checklist <br />Instructions: The MPCA or Delegated County staff should complete this form upon an inspection to evaluate non-NPDES permitted <br />feedlots for compliance with Minnesota feedlot rules and statutes. A copy of the form will be.retumed to the feedlot owner following the <br />inspection. _ <br />General Information <br />Name of facility: Shirley Smith / Cindy Bellamy Date of inspection (mmlddtyyyy): 9/22/2014 <br />Registration No: 163-123144 .Inspector Name: Richard Gruenes <br />Owner/Operator: Shirley Smith / Cindy Bellamy Others Present: Shirley Smith / Cindy Bellamy <br />Phone: 651-653-6217 - Fax: E-mail: <br />Weather Conditions (at time of inspection): clear and sunny <br />Facility Location <br />County: washington Twp: Cityof Hugo Sect: 3 Qtr: NE <br />Facility address: 17260 Ingersoll Ave. N. <br />City: Hugo State: MN Zip Code: 55038 Parcel ID: <br />Inspection Type . (check all that apply): Note: cannot be changed except via customization window/form <br />(v]Tacility Compliance . ❑ Land Application Level II Records Review ❑ Land Application Level III Field Inspection <br />A;. Feedlot History (Date format: mmtdd/yyyy) <br />Type of most recent inspection: Compliance Date of most recent inspection: 8/21/2014 <br />Type of most recent enforcement action: Date of enforcement action: <br />Permit Type: <br />Date of most recent registration: <br />Issuance Date: Expiration Date: <br />8/21/2014 double-click to <br />A.1 Does a MinnFarm or FLEval exist for the feedlot? <br />A2 Is the feedlot located in a Drinking Water Supply I <br />A.3 Is the feedlot located in Shoreland? <br />A.4 Enrolled in the Open Lot Agreement? <br />B. Feedlot Components Animal (head) Numbers <br />wq-f3-45e Feedlot (Non-NPDES) Inspection Checklist Revised 12-4-12. <br />