FORM DT1873 INSTRUCTIONS

Item 1. Enter the date of the inspection. Items 2., 3., 5., 6., 6a., 7., 8., and 9. for registered subsites will already be populated. If any of the information included in these items has changed or is incorrect, cross out the information and write in the correct data. Items 2., 3., 5., 6., 6a., 7., 8., and 9. for new (non-registered) subsites: Enter the new information for Items 6., 6a., 7., 8., and 9. Site Identification Numbers (Item 2.) and Subsite Label (Item 3.) will be established by WisDOT. Item 4. Enter your first and last name. Item 5. If a physical address (street number, street name, city, zip code) is not available for the site,

provide a description of the site’s location in relation to its surroundings.

Item 8. Whether a registered site or a new site, the response “Unknown” is used for empty or unknown material. “Various Liquids” (referring to tank subsites) is a placeholder term that also refers to an unknown material or will require a change to a material type.

For the checkbox in Item 8, a sand to salt ratio of 12:1 equals approximately 5% salt by weight. Check this box if the salt/sand subsite is less than 5% salt by weight.

Item 10.1.1. Stockpiles often do not have aprons like those for a shed, where the apron is in a fixed

location relative to the shed. The apron for a stockpile is the area in front of the working face of the stockpile, typically extending outward approximately the length of a typical dump truck (approximately 20 to 25 feet).

Item 10.1.2. As product is removed from the stockpile, any paved area exposed is the pad. Mark as “Not

Visible” if the pad is completed covered by material. Section 11: Complete only if the subsite is a structure. Otherwise, all items are checked “N/A.” Check the

type of structure. Whether repairs needed are minor or major is determined according to the judgment of the inspector using criteria supplied by WisDOT (refer to the Salt Storage Self-Inspection Guidance Document, available at the link on the bottom of this page).

Section 12: Complete only if the subsite is a tank. Otherwise all items are checked “N/A.” Check if the

subsite is a single or multiple tank. Whether repairs needed are minor or major is determined according to the judgment of the inspector using criteria supplied by WisDOT (refer to the Salt Storage Self-Inspection Guidance Document, available at the link on the bottom of this page).

Section 13: Complete only if the subsite is a stockpile or a crib. Otherwise all items are checked “N/A.” Items14.1.,14.2. Any of the stored material courser than dust is deemed material. Material leaked from the

door or cracks in the walls requires something other than “None.” Item 14.4. Material is adequately covered and not exposed to wind, rain, and snow. Item 14.5. Monthly material inventory records kept using form DT1874 or other similar method. Item 15. This is an area for the inspector to add notes to clarify responses or to provide more

descriptive information, especially for those responses checked “Moderate, Severe, or Major.”

Make sure all boxes in Items 10.2 through 14.5 are checked. The Salt Storage Inspection Self-Inspection Guidance Document can be accessed at the following link: https://wisconsindot.gov/Pages/doing-bus/local-gov/hwy-mnt/winter-maintenance/rd-slt-strg.aspx

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-468 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Barnes Inc. Steve Kamps

5. Site Address (use house number or emergency response number including zip) 6433 Nesbitt Road, Madison 53719

6.a Compliance Contact Telephone 608-845-3230

7. Directions To Site Location 1 mi east of Nesbitt Road and STH 18/151, Barnes Construction., CTH PD to Nesbitt Rd 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed Right bays.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-468 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Barnes Inc. Steve Kamps

5. Site Address (use house number or emergency response number including zip) 6433 Nesbitt Road, Madison 53719

6.a Compliance Contact Telephone 608-845-3230

7. Directions To Site Location 1 mi east of Nesbitt Road and STH 18/151, Barnes Construction., CTH PD to Nesbitt Rd 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed Center Bays.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-468 3.Subsite Label

5

4.Inspected By:

6. Owner and Compliance Contact Name Barnes Inc. Steve Kamps

5. Site Address (use house number or emergency response number including zip) 6433 Nesbitt Road, Madison 53719

6.a Compliance Contact Telephone 608-845-3230

7. Directions To Site Location 1 mi east of Nesbitt Road and STH 18/151, Barnes Construction., CTH PD to Nesbitt Rd 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Left Bays.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-468 3.Subsite Label

6

4.Inspected By:

6. Owner and Compliance Contact Name Barnes Inc. Steve Kamps

5. Site Address (use house number or emergency response number including zip) 6433 Nesbitt Road, Madison 53719

6.a Compliance Contact Telephone 608-845-3230

7. Directions To Site Location 1 mi east of Nesbitt Road and STH 18/151, Barnes Construction., CTH PD to Nesbitt Rd 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed. right bay.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-502 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Barnes Inc. Steve Kamps

5. Site Address (use house number or emergency response number including zip) 5545 Reiner Road, Sun Prairie 53590

6.a Compliance Contact Telephone 608-845-3230

7. Directions To Site Location North of Nelson Road and RR tracks 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-907 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Berryman Lawn and Landscape, Inc. Bryan J. Berryman Lawn and Landscape, INC

5. Site Address (use house number or emergency response number including zip) 513 State Farm Road, Deerfield 53531

6.a Compliance Contact Telephone 608-225-7517

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Hi-Arch Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-347 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Brian Schmidt Enterprises LLC Stephanie Schmidt/Brian Schmidt

5. Site Address (use house number or emergency response number including zip) 7273 Lodi Springfield Rd, Lodi 53555

6.a Compliance Contact Telephone 608-592-5990

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-347 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Brian Schmidt Enterprises LLC Stephanie Schmidt/Brian Schmidt

5. Site Address (use house number or emergency response number including zip) 7273 Lodi Springfield Rd, Lodi 53555

6.a Compliance Contact Telephone 608-592-5990

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed. Salt/Sand.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-84 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name City of Fitchburg Mark Hodel Street Supervisor

5. Site Address (use house number or emergency response number including zip) 2377 South Fish Hatchery Road, Fitchburg 53711-5405

6.a Compliance Contact Telephone 608-278-7860

7. Directions To Site Location 1/4 mile south of Irish Lane, 3 miles north of junction of CTH M, on South Fish Hatchery Road (CTH D). 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed 1/2

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-84 3.Subsite Label

4

4.Inspected By:

6. Owner and Compliance Contact Name City of Fitchburg Mark Hodel Street Supervisor

5. Site Address (use house number or emergency response number including zip) 2377 South Fish Hatchery Road, Fitchburg 53711-5405

6.a Compliance Contact Telephone 608-278-7860

7. Directions To Site Location 1/4 mile south of Irish Lane, 3 miles north of junction of CTH M, on South Fish Hatchery Road (CTH D). 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed 1/2

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-84 3.Subsite Label

5

4.Inspected By:

6. Owner and Compliance Contact Name City of Fitchburg Mark Hodel Street Supervisor

5. Site Address (use house number or emergency response number including zip) 2377 South Fish Hatchery Road, Fitchburg 53711-5405

6.a Compliance Contact Telephone 608-278-7860

7. Directions To Site Location 1/4 mile south of Irish Lane, 3 miles north of junction of CTH M, on South Fish Hatchery Road (CTH D). 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank, shop bldg east of salt shed.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-84 3.Subsite Label

6

4.Inspected By:

6. Owner and Compliance Contact Name City of Fitchburg Mark Hodel Street Supervisor

5. Site Address (use house number or emergency response number including zip) 2377 South Fish Hatchery Road, Fitchburg 53711-5405

6.a Compliance Contact Telephone 608-278-7860

7. Directions To Site Location 1/4 mile south of Irish Lane, 3 miles north of junction of CTH M, on South Fish Hatchery Road (CTH D). 8. Material stored at this subsite (Check only one) Various Liquids 9. Note of facility type and description

Facility Type: Tank Description: Tank (next to salt brine tank) Mix tank.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids √ Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-139 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison John Blotz, General Maintenance

5. Site Address (use house number or emergency response number including zip) 1501 West Badger Road, Madison 53713-2307

6.a Compliance Contact Telephone 608-267-4956

7. Directions To Site Location West end of Badger Road. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-139 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison John Blotz, General Maintenance

5. Site Address (use house number or emergency response number including zip) 1501 West Badger Road, Madison 53713-2307

6.a Compliance Contact Telephone 608-267-4956

7. Directions To Site Location West end of Badger Road. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Stock-Pile Description: Stockpile

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-139 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison John Blotz, General Maintenance

5. Site Address (use house number or emergency response number including zip) 1501 West Badger Road, Madison 53713-2307

6.a Compliance Contact Telephone 608-267-4956

7. Directions To Site Location West end of Badger Road. 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank (double) in garage. North of wooden shed.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-139 3.Subsite Label

4

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison John Blotz, General Maintenance

5. Site Address (use house number or emergency response number including zip) 1501 West Badger Road, Madison 53713-2307

6.a Compliance Contact Telephone 608-267-4956

7. Directions To Site Location West end of Badger Road. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Dome Description: Dome

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-140 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison Randy Ziegler, General Maintenance

5. Site Address (use house number or emergency response number including zip) 4602 Sycamore Avenue, Madison 53704-6461

6.a Compliance Contact Telephone 608-246-4536

7. Directions To Site Location USH 151, South on Mendota, continue on Mendota past railroad tracks. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed B (east)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-140 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison Randy Ziegler, General Maintenance

5. Site Address (use house number or emergency response number including zip) 4602 Sycamore Avenue, Madison 53704-6461

6.a Compliance Contact Telephone 608-246-4536

7. Directions To Site Location USH 151, South on Mendota, continue on Mendota past railroad tracks. 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tanks (2) north of garage - beat juice and brine

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-140 3.Subsite Label

4

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison Randy Ziegler, General Maintenance

5. Site Address (use house number or emergency response number including zip) 4602 Sycamore Avenue, Madison 53704-6461

6.a Compliance Contact Telephone 608-246-4536

7. Directions To Site Location USH 151, South on Mendota, continue on Mendota past railroad tracks. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed A (west)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-140 3.Subsite Label

5

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison Randy Ziegler, General Maintenance

5. Site Address (use house number or emergency response number including zip) 4602 Sycamore Avenue, Madison 53704-6461

6.a Compliance Contact Telephone 608-246-4536

7. Directions To Site Location USH 151, South on Mendota, continue on Mendota past railroad tracks. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Stock-Pile Description: Stockpile.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-466 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison John Blotz, General Maintenance

5. Site Address (use house number or emergency response number including zip) 402 South Point Rd, Verona 53593-9142

6.a Compliance Contact Telephone 608-266-4956

7. Directions To Site Location South Point Road, approximately 1/2 mile south of CTH M. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Hi-Arch Description: Hi-arch

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-466 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison John Blotz, General Maintenance

5. Site Address (use house number or emergency response number including zip) 402 South Point Rd, Verona 53593-9142

6.a Compliance Contact Telephone 608-266-4956

7. Directions To Site Location South Point Road, approximately 1/2 mile south of CTH M. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Stock-Pile Description: Stockpile. Reactivated site 03/01/17.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-466 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name City of Madison John Blotz, General Maintenance

5. Site Address (use house number or emergency response number including zip) 402 South Point Rd, Verona 53593-9142

6.a Compliance Contact Telephone 608-266-4956

7. Directions To Site Location South Point Road, approximately 1/2 mile south of CTH M. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Hi-Arch Description: Hi-Arch, salt/sand.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-313 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name City of Middleton Shawn Stauske, Dir. Public Works

5. Site Address (use house number or emergency response number including zip) 4330 Parmenter Street, Middleton 53562

6.a Compliance Contact Telephone 608-821-8370

7. Directions To Site Location 12 to Century 1 mile east, south on Laura Lane (building at NW corner of M and Laura Lane). 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-313 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name City of Middleton Shawn Stauske, Dir. Public Works

5. Site Address (use house number or emergency response number including zip) 4330 Parmenter Street, Middleton 53562

6.a Compliance Contact Telephone 608-821-8370

7. Directions To Site Location 12 to Century 1 mile east, south on Laura Lane (building at NW corner of M and Laura Lane). 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-313 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name City of Middleton Shawn Stauske, Dir. Public Works

5. Site Address (use house number or emergency response number including zip) 4330 Parmenter Street, Middleton 53562

6.a Compliance Contact Telephone 608-821-8370

7. Directions To Site Location 12 to Century 1 mile east, south on Laura Lane (building at NW corner of M and Laura Lane). 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-517 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name City of Monona Jeff Johnson

5. Site Address (use house number or emergency response number including zip) 851 Femrite Drive, Monona 53706

6.a Compliance Contact Telephone 608-222-2525

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-517 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name City of Monona Jeff Johnson

5. Site Address (use house number or emergency response number including zip) 851 Femrite Drive, Monona 53706

6.a Compliance Contact Telephone 608-222-2525

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description:

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-487 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name City of Stoughton Brett Hebert

5. Site Address (use house number or emergency response number including zip) 515 S. Fourth St., Stoughton 53589-2401

6.a Compliance Contact Telephone 608-873-6303

7. Directions To Site Location Business 51 (E. Main Street) then South on S. Fourth Street 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed. Left Bay.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-487 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name City of Stoughton Brett Hebert

5. Site Address (use house number or emergency response number including zip) 515 S. Fourth St., Stoughton 53589-2401

6.a Compliance Contact Telephone 608-873-6303

7. Directions To Site Location Business 51 (E. Main Street) then South on S. Fourth Street 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed. Right bay. .

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-487 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name City of Stoughton Brett Hebert

5. Site Address (use house number or emergency response number including zip) 515 S. Fourth St., Stoughton 53589-2401

6.a Compliance Contact Telephone 608-873-6303

7. Directions To Site Location Business 51 (E. Main Street) then South on S. Fourth Street 8. Material stored at this subsite (Check only one) Various Liquids 9. Note of facility type and description

Facility Type: Tank Description: Tank.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids √ Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-14 3.Subsite Label

4

4.Inspected By:

6. Owner and Compliance Contact Name City of Sun Prairie Lee Igl, Director DPW

5. Site Address (use house number or emergency response number including zip) 201 South Bristol, Sun Prairie 53590-2915

6.a Compliance Contact Telephone 608-825-0710

7. Directions To Site Location CTH N (south) to Park St. to Linnerud Dr., NE corner South Bristol and Linnerud Drive. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-491 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name City of Sun Prairie Lee Igl, Director of Public Works

5. Site Address (use house number or emergency response number including zip) 3030 Bailey Rd, Sun Prairie 53590

6.a Compliance Contact Telephone 608-837-3050

7. Directions To Site Location Behind city vehicle mtc shop. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-491 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name City of Sun Prairie Lee Igl, Director of Public Works

5. Site Address (use house number or emergency response number including zip) 3030 Bailey Rd, Sun Prairie 53590

6.a Compliance Contact Telephone 608-837-3050

7. Directions To Site Location Behind city vehicle mtc shop. 8. Material stored at this subsite (Check only one) Various Liquids 9. Note of facility type and description

Facility Type: Tank Description: SW Tank (mix)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids √ Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-491 3.Subsite Label

4

4.Inspected By:

6. Owner and Compliance Contact Name City of Sun Prairie Lee Igl, Director of Public Works

5. Site Address (use house number or emergency response number including zip) 3030 Bailey Rd, Sun Prairie 53590

6.a Compliance Contact Telephone 608-837-3050

7. Directions To Site Location Behind city vehicle mtc shop. 8. Material stored at this subsite (Check only one) Calcium Chloride - Liquid 9. Note of facility type and description

Facility Type: Tank Description: NW Tank.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride √ Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-491 3.Subsite Label

5

4.Inspected By:

6. Owner and Compliance Contact Name City of Sun Prairie Lee Igl, Director of Public Works

5. Site Address (use house number or emergency response number including zip) 3030 Bailey Rd, Sun Prairie 53590

6.a Compliance Contact Telephone 608-837-3050

7. Directions To Site Location Behind city vehicle mtc shop. 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: NE tank.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-508 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name City of Sun Prairie Lee Igl, Dir. of Public Works

5. Site Address (use house number or emergency response number including zip) 3026 Bailey Road, Sun Prairie 53590

6.a Compliance Contact Telephone 608-837-3050

7. Directions To Site Location Approxmiately 400 feet north of garage. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed. Canvas top (wht)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-337 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name City of Verona John Bublitz, Street Superintendent

5. Site Address (use house number or emergency response number including zip) 410 Investment Court, Verona 53593-8749

6.a Compliance Contact Telephone 608-845-6695

7. Directions To Site Location State Rd 69 (Paoli St) to Bruce to Investment Ct. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: West Shed (left bay).

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-337 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name City of Verona John Bublitz, Street Superintendent

5. Site Address (use house number or emergency response number including zip) 410 Investment Court, Verona 53593-8749

6.a Compliance Contact Telephone 608-845-6695

7. Directions To Site Location State Rd 69 (Paoli St) to Bruce to Investment Ct. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: West Shed (right bay)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-337 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name City of Verona John Bublitz, Street Superintendent

5. Site Address (use house number or emergency response number including zip) 410 Investment Court, Verona 53593-8749

6.a Compliance Contact Telephone 608-845-6695

7. Directions To Site Location State Rd 69 (Paoli St) to Bruce to Investment Ct. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: North Shed, 3rd bay from west end.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-1 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2520 County Rd B, Stoughton 53589-3309

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Corner of County Rd N and B 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: West

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-1 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2520 County Rd B, Stoughton 53589-3309

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Corner of County Rd N and B 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: East

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-1 3.Subsite Label

4

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2520 County Rd B, Stoughton 53589-3309

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Corner of County Rd N and B 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank in concrete and quanset style shed.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-17 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2302 Fish Hatchery Rd, Madison 53713-2436

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Corner of Fish Hatchery and Badger Road. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-17 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2302 Fish Hatchery Rd, Madison 53713-2436

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Corner of Fish Hatchery and Badger Road. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: (1/2)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-17 3.Subsite Label

6

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2302 Fish Hatchery Rd, Madison 53713-2436

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Corner of Fish Hatchery and Badger Road. 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank(4). Brine maker and 4 connected tanks inside new building.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-262 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 4587 State Rd 19, DeForest 53532-2512

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location State Rd 19 just West of I-90/94 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-262 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 4587 State Rd 19, DeForest 53532-2512

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location State Rd 19 just West of I-90/94 8. Material stored at this subsite (Check only one) Unknown 9. Note of facility type and description

Facility Type: Shed Description: (1/2) sand/salt

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown √

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-262 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 4587 State Rd 19, DeForest 53532-2512

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location State Rd 19 just West of I-90/94 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank north of shed.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-266 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2831 US Highway 12 & 18, Cottage Grove 53527-9762

6.a Compliance Contact Telephone 608-266-4039

7. Directions To Site Location Southeast corner of the intersection of USH 12 & 18 and Sigglekow Road. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Dome Description: (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-266 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2831 US Highway 12 & 18, Cottage Grove 53527-9762

6.a Compliance Contact Telephone 608-266-4039

7. Directions To Site Location Southeast corner of the intersection of USH 12 & 18 and Sigglekow Road. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Dome Description: (1/2)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-266 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2831 US Highway 12 & 18, Cottage Grove 53527-9762

6.a Compliance Contact Telephone 608-266-4039

7. Directions To Site Location Southeast corner of the intersection of USH 12 & 18 and Sigglekow Road. 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank (Single)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-479 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 3650 County Rd T, Madison 53718

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Commercial street / Road T between north and south bound I-90/I-39/I-94 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Hi-Arch Description: STATE FUNDING OF 90% . CHANGE MADE WITH MIKE SPROUL ON 4/4/05 PER DAVE PILON.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-479 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 3650 County Rd T, Madison 53718

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Commercial street / Road T between north and south bound I-90/I-39/I-94 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank inside shed attached to salt Hi-arch. Two tanks piped together.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-486 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 6159 US Highway 12, Dane 53529-9762

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Off of County Rd P South 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Hi-Arch Description: Hi-Arch 1/2

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-486 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 6159 US Highway 12, Dane 53529-9762

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Off of County Rd P South 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Hi-Arch Description: Hi-Arch (1/2)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-486 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 6159 US Highway 12, Dane 53529-9762

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Off of County Rd P South 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank outside hi-arch

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-501 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Commissioner

5. Site Address (use house number or emergency response number including zip) 1246 or 1274 Greenway Road, Columbus 53925

6.a Compliance Contact Telephone 608-266-4039

7. Directions To Site Location US 151 at County V 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Hi-Arch Description: Hi-Arch

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-501 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Commissioner

5. Site Address (use house number or emergency response number including zip) 1246 or 1274 Greenway Road, Columbus 53925

6.a Compliance Contact Telephone 608-266-4039

7. Directions To Site Location US 151 at County V 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Hi-Arch Description: Hi-Arch, both material in same hi-arch.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-501 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Commissioner

5. Site Address (use house number or emergency response number including zip) 1246 or 1274 Greenway Road, Columbus 53925

6.a Compliance Contact Telephone 608-266-4039

7. Directions To Site Location US 151 at County V 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank in Hi-Arch.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-505 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) I39 WB MM149.5, Stoughton 53589

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Old weigh station along WB 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed, Canvas top at old weight station.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-505 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) I39 WB MM149.5, Stoughton 53589

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location Old weigh station along WB 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-524 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 3103 Luds Lane, McFarland, WI 53558

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed to be built 2017

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-12 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2737 STH 78, Mount Horeb 53572-1472

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location County Highway Garage, State Rd 78 West of Mount. Horeb. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: West shed.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-12 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2737 STH 78, Mount Horeb 53572-1472

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location County Highway Garage, State Rd 78 West of Mount. Horeb. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: East shed. The DOT alloted changed to 1000 from 800. change made with Mike Sproul on 4-4-05 per Dave Pilon.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-12 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Dane County Dane County Highway Commissioner

5. Site Address (use house number or emergency response number including zip) 2737 STH 78, Mount Horeb 53572-1472

6.a Compliance Contact Telephone 608-266-4012

7. Directions To Site Location County Highway Garage, State Rd 78 West of Mount. Horeb. 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: Tank, west side of west shed.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-903 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Detroit Salt Company Brandon Burdick - WATCO

5. Site Address (use house number or emergency response number including zip) 1890 E. Johnson St., Madison 53704

6.a Compliance Contact Telephone 608-444-4271

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Stock-Pile Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-510 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Epic Systems Corporation Andy Popp

5. Site Address (use house number or emergency response number including zip) 2409 Epic Lane, Verona 53593

6.a Compliance Contact Telephone 608-777-2075

7. Directions To Site Location from USH 151 s take exit 76/Epic Ln, merge onto Epic Ln, take left on epic Ln, take left at 1st farm. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-510 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Epic Systems Corporation Andy Popp

5. Site Address (use house number or emergency response number including zip) 2409 Epic Lane, Verona 53593

6.a Compliance Contact Telephone 608-777-2075

7. Directions To Site Location from USH 151 s take exit 76/Epic Ln, merge onto Epic Ln, take left on epic Ln, take left at 1st farm. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-389 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Hammersley Stone Company Inc Nathan Hammersley

5. Site Address (use house number or emergency response number including zip) 6292 Lacy Road, Fitchburg 53711

6.a Compliance Contact Telephone 608-845-7804

7. Directions To Site Location 1/3 mi east of Fitchrona and Lacy, Hammersley Stone. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-25 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name John Kasimatis John Kasimatis, JAK's Landscaping

5. Site Address (use house number or emergency response number including zip) 215 Legion Street, Verona 53593-1307

6.a Compliance Contact Telephone 608-832-6399

7. Directions To Site Location Business 15 (W Verona Avenue) or State Rd 69 (Paoli St.) to S Nine Mound Rd to Legion St 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-525 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name McFarland Jim Hessling

5. Site Address (use house number or emergency response number including zip) 5115 Terminal Drive, McFarland 53558

6.a Compliance Contact Telephone 608-838-7287

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Site also has 500G- Mg Cl liquid and 5000 G salt Brine tanks

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-499 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Middleton Farmers Coop Tim Stelpflug

5. Site Address (use house number or emergency response number including zip) 1756 Pleasant View Rd, Middleton 53562-0348

6.a Compliance Contact Telephone 608-831-5921

7. Directions To Site Location Exit 251 USH 14 West Left on Pleasant View Rd Left on Quarry Rd - White building (Building C) near end of Quarry Rd 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: large white shed with multiple bays inside.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-499 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Middleton Farmers Coop Tim Stelpflug

5. Site Address (use house number or emergency response number including zip) 1756 Pleasant View Rd, Middleton 53562-0348

6.a Compliance Contact Telephone 608-831-5921

7. Directions To Site Location Exit 251 USH 14 West Left on Pleasant View Rd Left on Quarry Rd - White building (Building C) near end of Quarry Rd 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-499 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Middleton Farmers Coop Tim Stelpflug

5. Site Address (use house number or emergency response number including zip) 1756 Pleasant View Rd, Middleton 53562-0348

6.a Compliance Contact Telephone 608-831-5921

7. Directions To Site Location Exit 251 USH 14 West Left on Pleasant View Rd Left on Quarry Rd - White building (Building C) near end of Quarry Rd 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed. Ice slicer/salt mix.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-79 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Albion Andy Decker

5. Site Address (use house number or emergency response number including zip) 597 Academy Drive, Albion 53534-9537

6.a Compliance Contact Telephone 608-884-2283

7. Directions To Site Location West side of park, at Town Shop 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-79 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Albion Andy Decker

5. Site Address (use house number or emergency response number including zip) 597 Academy Drive, Albion 53534-9537

6.a Compliance Contact Telephone 608-884-2283

7. Directions To Site Location West side of park, at Town Shop 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-249 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Berry Brenda Kahl; Clerk/Treasurer

5. Site Address (use house number or emergency response number including zip) 9036 State Rd 19, Mazomanie 53560-9750

6.a Compliance Contact Telephone 608-767-4152

7. Directions To Site Location East of Old Settlers Rd on State Rd 19 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-249 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Berry Brenda Kahl; Clerk/Treasurer

5. Site Address (use house number or emergency response number including zip) 9036 State Rd 19, Mazomanie 53560-9750

6.a Compliance Contact Telephone 608-767-4152

7. Directions To Site Location East of Old Settlers Rd on State Rd 19 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-133 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Black Earth Al Schroeder, Patrolman

5. Site Address (use house number or emergency response number including zip) 1103 Center Street, Black Earth 53515-9593

6.a Compliance Contact Telephone 608-206-2003

7. Directions To Site Location Center Street by the Black Earth Grade School, Corner of Center Street & Webb Street, long wooden shed. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-133 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Black Earth Al Schroeder, Patrolman

5. Site Address (use house number or emergency response number including zip) 1103 Center Street, Black Earth 53515-9593

6.a Compliance Contact Telephone 608-206-2003

7. Directions To Site Location Center Street by the Black Earth Grade School, Corner of Center Street & Webb Street, long wooden shed. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-490 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Blue Mounds Dennis Jelle

5. Site Address (use house number or emergency response number including zip) 10566 Blue Vista Road, Blue Mounds 53517

6.a Compliance Contact Telephone 608-437-8260

7. Directions To Site Location 2.5 Milew west of Mt. Horeb at corner of CTH ID & Blue Vista Road. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed S 1/2.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-490 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Blue Mounds Dennis Jelle

5. Site Address (use house number or emergency response number including zip) 10566 Blue Vista Road, Blue Mounds 53517

6.a Compliance Contact Telephone 608-437-8260

7. Directions To Site Location 2.5 Milew west of Mt. Horeb at corner of CTH ID & Blue Vista Road. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed N 1/2.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-467 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Bristol Lonn Hendrickson, Town of Bristol

5. Site Address (use house number or emergency response number including zip) 7747 County Rd N, Sun Prairie 53590-9502

6.a Compliance Contact Telephone 608-712-3523

7. Directions To Site Location County Rd N north of County Rd V, Town of Bristol. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-504 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Christiana George Waag

5. Site Address (use house number or emergency response number including zip) 773 Koshkonong Rd, Cambridge 53523

6.a Compliance Contact Telephone 608-423-3816

7. Directions To Site Location 12/18 towards Cambridge, turn right (south) on to Hwy 73, go 3 miles to the corner of 73 and Koshkonong Rd. turn left 500 feet east of intersection. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-504 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Christiana George Waag

5. Site Address (use house number or emergency response number including zip) 773 Koshkonong Rd, Cambridge 53523

6.a Compliance Contact Telephone 608-423-3816

7. Directions To Site Location 12/18 towards Cambridge, turn right (south) on to Hwy 73, go 3 miles to the corner of 73 and Koshkonong Rd. turn left 500 feet east of intersection. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: 25/75%

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-95 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Cottage Grove Jeff Smith Highway Superintendent

5. Site Address (use house number or emergency response number including zip) 4062 County Rd N, Cottage Grove 53527-9503

6.a Compliance Contact Telephone 608-839-4767

7. Directions To Site Location South County Rd N at Village limits 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-95 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Cottage Grove Jeff Smith Highway Superintendent

5. Site Address (use house number or emergency response number including zip) 4062 County Rd N, Cottage Grove 53527-9503

6.a Compliance Contact Telephone 608-839-4767

7. Directions To Site Location South County Rd N at Village limits 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Concrete underground shed

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-95 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Town of Cottage Grove Jeff Smith Highway Superintendent

5. Site Address (use house number or emergency response number including zip) 4062 County Rd N, Cottage Grove 53527-9503

6.a Compliance Contact Telephone 608-839-4767

7. Directions To Site Location South County Rd N at Village limits 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed. concrete underground.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-143 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Cross Plains Greg Hyer, Chair

5. Site Address (use house number or emergency response number including zip) 8697 Mineral Point Road, Cross Plains 53528-8810

6.a Compliance Contact Telephone 608-320-3243

7. Directions To Site Location West of the Intersection of County Rd S/P and West Mineral Point Rd 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Concrete/wood shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-143 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Cross Plains Greg Hyer, Chair

5. Site Address (use house number or emergency response number including zip) 8697 Mineral Point Road, Cross Plains 53528-8810

6.a Compliance Contact Telephone 608-320-3243

7. Directions To Site Location West of the Intersection of County Rd S/P and West Mineral Point Rd 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Crib inside west metal shed.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-52 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Dane Robert Lee Chair

5. Site Address (use house number or emergency response number including zip) 213 West Main Street, Dane 53529-9797

6.a Compliance Contact Telephone 608-592-3636

7. Directions To Site Location State Rd 113, West Village limits 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-167 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Deerfield Town of Deerfield

5. Site Address (use house number or emergency response number including zip) 838 London Road, Deerfield 53531-9572

6.a Compliance Contact Telephone 608-764-5615

7. Directions To Site Location South Deerfield limits, off of State Rd 73, Town of Deerfield. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Left bay, concrete shed.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-167 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Deerfield Town of Deerfield

5. Site Address (use house number or emergency response number including zip) 838 London Road, Deerfield 53531-9572

6.a Compliance Contact Telephone 608-764-5615

7. Directions To Site Location South Deerfield limits, off of State Rd 73, Town of Deerfield. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Concrete shed, right bay.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-519 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Dunkirk Town of Dunkirk

5. Site Address (use house number or emergency response number including zip) 654 CTH N, Stoughton 53589

6.a Compliance Contact Telephone 608-873-9177

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-519 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Dunkirk Town of Dunkirk

5. Site Address (use house number or emergency response number including zip) 654 CTH N, Stoughton 53589

6.a Compliance Contact Telephone 608-873-9177

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-210 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Dunn Jay Hoel

5. Site Address (use house number or emergency response number including zip) 4156 County Rd B, Mc Farland 53558-9754

6.a Compliance Contact Telephone 608-838-1081

7. Directions To Site Location Intersection County Rd B and Keenan Road, Town of Dunn. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: North shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-210 3.Subsite Label

4

4.Inspected By:

6. Owner and Compliance Contact Name Town of Dunn Jay Hoel

5. Site Address (use house number or emergency response number including zip) 4156 County Rd B, Mc Farland 53558-9754

6.a Compliance Contact Telephone 608-838-1081

7. Directions To Site Location Intersection County Rd B and Keenan Road, Town of Dunn. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: South shed.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-18 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Madison Pat Crossen, Supervisor/Foreman

5. Site Address (use house number or emergency response number including zip) 2120 Fish Hatchery Road, Madison 53713-1253

6.a Compliance Contact Telephone 608-210-7207

7. Directions To Site Location Town of Madison, Corner of Fish Hatchery Rd and RR tracks. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (west end of garage)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-211 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Mazomanie Fred Wolf, Chair/Maria VanCleve, Clerk

5. Site Address (use house number or emergency response number including zip) 711 West Hudson, Mazomanie 53560-9326

6.a Compliance Contact Telephone 608-795-2920

7. Directions To Site Location Highway 14, N on Brodhead (CTH Y), W on Hudson. at Mazomanie Town Hall 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed. North section of shed/overhang.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-211 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Mazomanie Fred Wolf, Chair/Maria VanCleve, Clerk

5. Site Address (use house number or emergency response number including zip) 711 West Hudson, Mazomanie 53560-9326

6.a Compliance Contact Telephone 608-795-2920

7. Directions To Site Location Highway 14, N on Brodhead (CTH Y), W on Hudson. at Mazomanie Town Hall 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: South end of shed.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-219 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Medina Jim Hellenbrand, Town of Medina Petrolman

5. Site Address (use house number or emergency response number including zip) 634 State Rd 19, Marshall 53559

6.a Compliance Contact Telephone 608-655-3030

7. Directions To Site Location State Rd 19 East at Marshall Village limits 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2) Green shed.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-219 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Medina Jim Hellenbrand, Town of Medina Petrolman

5. Site Address (use house number or emergency response number including zip) 634 State Rd 19, Marshall 53559

6.a Compliance Contact Telephone 608-655-3030

7. Directions To Site Location State Rd 19 East at Marshall Village limits 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2). Reassigned from storage site 220 on 5/8/01. Stored in same green shed as the salt.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-24 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Town of Middleton Fred Hankel, Inspector

5. Site Address (use house number or emergency response number including zip) 3593 Pioneer Rd, Verona 53593

6.a Compliance Contact Telephone 608-833-5887

7. Directions To Site Location Enter on Pioneer Rd, South of Old Sauk Rd West, Town of Middleton. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed, behind fire department.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-24 3.Subsite Label

4

4.Inspected By:

6. Owner and Compliance Contact Name Town of Middleton Fred Hankel, Inspector

5. Site Address (use house number or emergency response number including zip) 3593 Pioneer Rd, Verona 53593

6.a Compliance Contact Telephone 608-833-5887

7. Directions To Site Location Enter on Pioneer Rd, South of Old Sauk Rd West, Town of Middleton. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-172 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Montrose Mark Mussehl

5. Site Address (use house number or emergency response number including zip) 1415 Range Trail, Verona 53593-9348

6.a Compliance Contact Telephone 608-424-3848

7. Directions To Site Location On Range Trail north of County Rd PB in Village of Paoli 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: White metal shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-88 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Oregon Abel Schultz

5. Site Address (use house number or emergency response number including zip) 1138 Union Road, Oregon 53575-2742

6.a Compliance Contact Telephone 608-835-3200

7. Directions To Site Location SW limits of Village of Oregon, State Rd 138 to Janesvile St. left on S Perry Pkwy, left on Union Rd 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-335 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Perry Roger A. Kittleson

5. Site Address (use house number or emergency response number including zip) 1386 State Rd 78 South, Mount Horeb 53572-2818

6.a Compliance Contact Telephone 608-523-4379

7. Directions To Site Location South of State Rd 78 and County Rd H 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-134 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Pleasant Springs Town of Pleasant Springs, Public Works

5. Site Address (use house number or emergency response number including zip) 2354 County Rd N, Stoughton 53589-2875

6.a Compliance Contact Telephone 608-205-9169

7. Directions To Site Location North of County Rd B and N Intersection. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Small white shed, concrete shed.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-134 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Pleasant Springs Town of Pleasant Springs, Public Works

5. Site Address (use house number or emergency response number including zip) 2354 County Rd N, Stoughton 53589-2875

6.a Compliance Contact Telephone 608-205-9169

7. Directions To Site Location North of County Rd B and N Intersection. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Large brown shed, wood shed.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-242 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Primrose Ruth Hansen, Clerk

5. Site Address (use house number or emergency response number including zip) 8468 County Rd A, Verona 53593-9496

6.a Compliance Contact Telephone 608-832-4856

7. Directions To Site Location East of County Rd A and U Intersection 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: West shed

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-218 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Roxbury Robert Pings, Clerk

5. Site Address (use house number or emergency response number including zip) 7167 Kippley Road, Sauk City 53583-9574

6.a Compliance Contact Telephone 608-643-4762

7. Directions To Site Location Roxbury Town Hall , West of Sauk City. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (North 1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-218 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Town of Roxbury Robert Pings, Clerk

5. Site Address (use house number or emergency response number including zip) 7167 Kippley Road, Sauk City 53583-9574

6.a Compliance Contact Telephone 608-643-4762

7. Directions To Site Location Roxbury Town Hall , West of Sauk City. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed. South 1/2

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-273 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Rutland Mark Porter, Chair

5. Site Address (use house number or emergency response number including zip) 785 Center Road, Stoughton 53589-3919

6.a Compliance Contact Telephone 608-455-3925

7. Directions To Site Location Town Hall and Garages, South of County Rd A and Center Road Intersection. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Quanset Shed (north crib inside)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-273 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Rutland Mark Porter, Chair

5. Site Address (use house number or emergency response number including zip) 785 Center Road, Stoughton 53589-3919

6.a Compliance Contact Telephone 608-455-3925

7. Directions To Site Location Town Hall and Garages, South of County Rd A and Center Road Intersection. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Quanset Shed (south crib inside).

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-206 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Springdale Devin Dahlk, Town Patrolman

5. Site Address (use house number or emergency response number including zip) 2367 Town Hall Road, Mount Horeb 53572-2454

6.a Compliance Contact Telephone 608-437-6230

7. Directions To Site Location Business 18/151 to Ridgeview Rd. South on Town Hall Rd over US 18/151, 3 miles South 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed 1/2.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-206 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Springdale Devin Dahlk, Town Patrolman

5. Site Address (use house number or emergency response number including zip) 2367 Town Hall Road, Mount Horeb 53572-2454

6.a Compliance Contact Telephone 608-437-6230

7. Directions To Site Location Business 18/151 to Ridgeview Rd. South on Town Hall Rd over US 18/151, 3 miles South 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed 1/2.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-89 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Springfield Carolyn Hacker, Clerk

5. Site Address (use house number or emergency response number including zip) 6157 County Rd P, Dane 53529-9760

6.a Compliance Contact Telephone 608-849-7887

7. Directions To Site Location Junction County Rd P and Highway 12/19 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (west bay)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-89 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Springfield Carolyn Hacker, Clerk

5. Site Address (use house number or emergency response number including zip) 6157 County Rd P, Dane 53529-9760

6.a Compliance Contact Telephone 608-849-7887

7. Directions To Site Location Junction County Rd P and Highway 12/19 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (east bay)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-141 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Sun Prairie Wesley Dorshorst

5. Site Address (use house number or emergency response number including zip) 5556 Twin Lane Road, Marshall 53559-8917

6.a Compliance Contact Telephone 608-698-6200

7. Directions To Site Location Town of Sun Prairie Garage to Twin Lane Road, North of County Rd T 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: North shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-209 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Vermont Town Hall

5. Site Address (use house number or emergency response number including zip) 4017 County Rd JJ, Black Earth 53515-9726

6.a Compliance Contact Telephone 608-767-2457

7. Directions To Site Location Town of Vermont 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Wood shed

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-904 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Verona Amanda Arnold

5. Site Address (use house number or emergency response number including zip) 7669 CTH PD, Verona 53593

6.a Compliance Contact Telephone 608-845-7187

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-137 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Vienna Kathleen Clark, Clerk

5. Site Address (use house number or emergency response number including zip) 7161 County Rd I, De Forest 53532-1959

6.a Compliance Contact Telephone 608-846-3800

7. Directions To Site Location South County Rd I at County Rd V 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-99 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Westport Thomas G Wilson Clerk Treasurer

5. Site Address (use house number or emergency response number including zip) 5387 Mary Lake Road, Waunakee 53597-9128

6.a Compliance Contact Telephone 608-849-4372

7. Directions To Site Location North of County Rd M on Mary Lake Rd. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-99 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Westport Thomas G Wilson Clerk Treasurer

5. Site Address (use house number or emergency response number including zip) 5387 Mary Lake Road, Waunakee 53597-9128

6.a Compliance Contact Telephone 608-849-4372

7. Directions To Site Location North of County Rd M on Mary Lake Rd. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-99 3.Subsite Label

3

4.Inspected By:

6. Owner and Compliance Contact Name Town of Westport Thomas G Wilson Clerk Treasurer

5. Site Address (use house number or emergency response number including zip) 5387 Mary Lake Road, Waunakee 53597-9128

6.a Compliance Contact Telephone 608-849-4372

7. Directions To Site Location North of County Rd M on Mary Lake Rd. 8. Material stored at this subsite (Check only one) Various Liquids 9. Note of facility type and description

Facility Type: Tank Description: 1,000-Gallon (Mix Tank)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids √ Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-99 3.Subsite Label

4

4.Inspected By:

6. Owner and Compliance Contact Name Town of Westport Thomas G Wilson Clerk Treasurer

5. Site Address (use house number or emergency response number including zip) 5387 Mary Lake Road, Waunakee 53597-9128

6.a Compliance Contact Telephone 608-849-4372

7. Directions To Site Location North of County Rd M on Mary Lake Rd. 8. Material stored at this subsite (Check only one) Various Liquids 9. Note of facility type and description

Facility Type: Tank Description: 1,500-Gallon Tank - Geo Melt.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids √ Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-99 3.Subsite Label

5

4.Inspected By:

6. Owner and Compliance Contact Name Town of Westport Thomas G Wilson Clerk Treasurer

5. Site Address (use house number or emergency response number including zip) 5387 Mary Lake Road, Waunakee 53597-9128

6.a Compliance Contact Telephone 608-849-4372

7. Directions To Site Location North of County Rd M on Mary Lake Rd. 8. Material stored at this subsite (Check only one) Various Liquids 9. Note of facility type and description

Facility Type: Tank Description: 1,550-Gallon Tank.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids √ Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-99 3.Subsite Label

6

4.Inspected By:

6. Owner and Compliance Contact Name Town of Westport Thomas G Wilson Clerk Treasurer

5. Site Address (use house number or emergency response number including zip) 5387 Mary Lake Road, Waunakee 53597-9128

6.a Compliance Contact Telephone 608-849-4372

7. Directions To Site Location North of County Rd M on Mary Lake Rd. 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description: 3,000-Gallon Tank,

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-156 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of Windsor Jim Fredenberg

5. Site Address (use house number or emergency response number including zip) 4104 Mueller Road, De Forest 53532-2333

6.a Compliance Contact Telephone 608-846-3854

7. Directions To Site Location East of Highway 51 on Mueller Road, Town of Windsor. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (west end)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-156 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of Windsor Jim Fredenberg

5. Site Address (use house number or emergency response number including zip) 4104 Mueller Road, De Forest 53532-2333

6.a Compliance Contact Telephone 608-846-3854

7. Directions To Site Location East of Highway 51 on Mueller Road, Town of Windsor. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (west end)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-80 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Town of York John V Prosser

5. Site Address (use house number or emergency response number including zip) 796 York Center Road, Marshall 53559-9443

6.a Compliance Contact Telephone 920-623-2411

7. Directions To Site Location Corner of State Rd 73 and York Center Rd. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-80 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Town of York John V Prosser

5. Site Address (use house number or emergency response number including zip) 796 York Center Road, Marshall 53559-9443

6.a Compliance Contact Telephone 920-623-2411

7. Directions To Site Location Corner of State Rd 73 and York Center Rd. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (1/2)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-306 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name U.W. Physical Plant Grounds Dept. Ellen Agnew, UW-Madison

5. Site Address (use house number or emergency response number including zip) 515 Herrick Drive, Madison 53706-1001

6.a Compliance Contact Telephone 608-262-2954

7. Directions To Site Location Behind Horticultural Research Annex, on UW Campus, Walnut Street to Linden to Herrick. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed #105 (south bay)

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-306 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name U.W. Physical Plant Grounds Dept. Ellen Agnew, UW-Madison

5. Site Address (use house number or emergency response number including zip) 515 Herrick Drive, Madison 53706-1001

6.a Compliance Contact Telephone 608-262-2954

7. Directions To Site Location Behind Horticultural Research Annex, on UW Campus, Walnut Street to Linden to Herrick. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed #105 (north bay)

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-370 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Belleville Tim Francois, Director of Public Works

5. Site Address (use house number or emergency response number including zip) 421 East Pearl Street, Belleville 53508-9315

6.a Compliance Contact Telephone 608-424-3666

7. Directions To Site Location E. Main to S Park to E Pearl, in old sewer treatment bldg NW of electrical substation.. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Dome Description: Dome

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-370 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Village of Belleville Tim Francois, Director of Public Works

5. Site Address (use house number or emergency response number including zip) 421 East Pearl Street, Belleville 53508-9315

6.a Compliance Contact Telephone 608-424-3666

7. Directions To Site Location E. Main to S Park to E Pearl, in old sewer treatment bldg NW of electrical substation.. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Dome Description: Dome.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-482 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Blue Mounds Dan Foster

5. Site Address (use house number or emergency response number including zip) 10961 County Road ID, Blue Mounds 53517-9692

6.a Compliance Contact Telephone 608-576-0036

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-507 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Cambridge Christopher Brown, Director of Public Works

5. Site Address (use house number or emergency response number including zip) 206 River Street, Cambridge 53523

6.a Compliance Contact Telephone 608-423-3712

7. Directions To Site Location Hwy 12/Nort on Spring/West on North/North on River Street. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-509 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Cottage Grove JJ Larson

5. Site Address (use house number or emergency response number including zip) 225 Bonnie Rd, Cottage Grove 53527

6.a Compliance Contact Telephone 608-839-5813

7. Directions To Site Location Main Street to Progress Drive, to Bonnie Road 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-521 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Cross Plains Jerry Gray

5. Site Address (use house number or emergency response number including zip) 1225 Bourbon Road, Cross Plains 53528

6.a Compliance Contact Telephone 608-235-1054

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-131 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Dane David Koenig Jr Director of Public Works

5. Site Address (use house number or emergency response number including zip) 201 Snyder Drive, Dane 53529-9501

6.a Compliance Contact Telephone 608-849-5422

7. Directions To Site Location Highway 113 to 201 Snyder Drive, to Traex Plaza, follow around west side of building to gate, yard waste site, white building behine Traex. GPS at gate. High Street (east), Third Street (south) to Snyder (east) - behind large business. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-314 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of DeForest Mark Tenjum, Public Works Supervisor

5. Site Address (use house number or emergency response number including zip) 205 Deforest Street, De Forest 53532-1561

6.a Compliance Contact Telephone 608-846-6761

7. Directions To Site Location Main St (County Rd CV) to Commerce St., Public Works Garage, Village of DeForest. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-451 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Deerfield John Doyle Director of Public Works

5. Site Address (use house number or emergency response number including zip) 205 North Industrial Park Drive, Deerfield 53531

6.a Compliance Contact Telephone 608-764-5497

7. Directions To Site Location STH 73 (N. Main str.) to N Industrial Park Road, at Public Works near Wastewater treatment plant, City of Deerfield. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed east 1/2

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-451 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Village of Deerfield John Doyle Director of Public Works

5. Site Address (use house number or emergency response number including zip) 205 North Industrial Park Drive, Deerfield 53531

6.a Compliance Contact Telephone 608-764-5497

7. Directions To Site Location STH 73 (N. Main str.) to N Industrial Park Road, at Public Works near Wastewater treatment plant, City of Deerfield. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed west 1/2.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-100 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Village of Maple Bluff Thomas A Schroeder

5. Site Address (use house number or emergency response number including zip) 18 Oxford Place, Madison 53704-5955

6.a Compliance Contact Telephone 608-244-3048

7. Directions To Site Location Maple bluff village center, sherman avenue south to oxford place, just after railroad track 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed (north bay). Reassigned from storage site 338 on 5/8/01.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-503 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Marshall Brian Koll

5. Site Address (use house number or emergency response number including zip) 515 Best Built Parkway, Marshall 53559

6.a Compliance Contact Telephone 608-381-9380

7. Directions To Site Location None 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed. Salt/Sand.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-258 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Mount Horeb Laurel Grindle Director of Public Works

5. Site Address (use house number or emergency response number including zip) 301 Blue Mounds Street, Mount Horeb 53572-2160

6.a Compliance Contact Telephone 608-437-3351

7. Directions To Site Location Bus 18/151 (W. Main) to Blue Mounds St., turn south, Village of Mount Horeb garage. 8. Material stored at this subsite (Check only one) Salt / Sand 9. Note of facility type and description

Facility Type: Shed Description: Shed, concrete apron.

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-165 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Oregon Jeff Rau

5. Site Address (use house number or emergency response number including zip) 388 Park St, Oregon 53575-1568

6.a Compliance Contact Telephone 608-835-6290

7. Directions To Site Location State Rd 138 to Janesville St, right on S. Oak St, on Park St, Department of Public Works 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-506 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Shorewood Hills John Mitmoen, Public Works

5. Site Address (use house number or emergency response number including zip) 4502 Old Middleton Road, Madison 53705

6.a Compliance Contact Telephone 608-267-2680

7. Directions To Site Location North of University Avenue on Old Middleton Road, Village of Shorewood Hills. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-428 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name Village of Waunakee William Frederick, Street Superintendent

5. Site Address (use house number or emergency response number including zip) 504 Moravian Valley Road, Waunakee 53597-9594

6.a Compliance Contact Telephone 608-849-5892

7. Directions To Site Location State Rd 113/19 south on Raemish Rd to Frank H. Street to Moravian Valley Road, Village of Waunakee Public Works 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: Shed

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-428 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name Village of Waunakee William Frederick, Street Superintendent

5. Site Address (use house number or emergency response number including zip) 504 Moravian Valley Road, Waunakee 53597-9594

6.a Compliance Contact Telephone 608-849-5892

7. Directions To Site Location State Rd 113/19 south on Raemish Rd to Frank H. Street to Moravian Valley Road, Village of Waunakee Public Works 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description: West shed.

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-906 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name WisDOT WisDOT - SW Region

5. Site Address (use house number or emergency response number including zip) 1015 County Highway A, Edgerton 53534

6.a Compliance Contact Telephone 608-246-3800

7. Directions To Site Location I39 to USH 51 (MM156), West on USH 51 to CTH a, South on CTH A to site location on left. 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-905 3.Subsite Label

1

4.Inspected By:

6. Owner and Compliance Contact Name WisDOT Verona Shed WisDOT

5. Site Address (use house number or emergency response number including zip) 4391 Maple Grove Drive, Verona 53593

6.a Compliance Contact Telephone 608-246-3800

7. Directions To Site Location 18/151 South to Verona Rd to Maples Grove Drive 8. Material stored at this subsite (Check only one) Salt 9. Note of facility type and description

Facility Type: Shed Description:

Bulk road salt √ Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used

ROAD CHEMICAL STORAGE SUBSITE INSPECTION FORM Wisconsin Department of Transportation DT1873 2008 Trans 277 Wisconsin Administrative Code 1. Inspection Date

2.Site Identification Number

1-13-905 3.Subsite Label

2

4.Inspected By:

6. Owner and Compliance Contact Name WisDOT Verona Shed WisDOT

5. Site Address (use house number or emergency response number including zip) 4391 Maple Grove Drive, Verona 53593

6.a Compliance Contact Telephone 608-246-3800

7. Directions To Site Location 18/151 South to Verona Rd to Maples Grove Drive 8. Material stored at this subsite (Check only one) Salt Brine 9. Note of facility type and description

Facility Type: Tank Description:

Bulk road salt Liquid magnesium chloride Salt sand mixture (>5% salt by weight) Dry magnesium chloride Liquid calcium chloride Ice ban Dry calcium chloride Various Liquids Salt brine Unknown

Check if Sand/Salt mixture is less than or equal to 5% salt by weight

10. Pad and Apron at this subsite 10.1 Solid material is stored on a concrete or asphalt pad (If No or N/A, go to 10.2) Yes No N/A

10.1.1 Defects (cracks, holes, etc.) in apron are: (see maintenance manual guideline 30.10 A1A-D)

No apron Not visible Absent Slight Moderate Severe

10.1.2 Defects (cracks, holes, etc.) in pad are (see maintenance manual guideline 30.10 A1A-D)

Not visible Absent Slight Moderate Severe

10.1.3 The pad under the stockpile is adequately raised, crowned or sloped to direct water away from the material.

Yes

No

10.2 If present, the design and condition of the berm serving this subsite or the entire site contains runoff on the site’s surface.

Yes

No

N/A

10.3 If present, a catch basin or holding pond serves only this subsite or this subsite along with other subsites

Yes

No

N/A

11. If this subsite is a structure Repairs needed to Shed ____ Crib ____ 11.1 The roof None Minor Major N/A Hi Arch ____ Other ____ 11.2 The walls None Minor Major N/A Dome ____ 11.3 The door(s) None Minor Major N/A

12. If this subsite is a tank Repairs needed to Single ____ 12.1 The tank None Minor Major N/A Multiple ____ Num ____ 12.2 The tank support structure None Minor Major N/A 12.3 Tank fixtures None Minor Major N/A 12.4 The spill containment device None Minor Major N/A

13. If this subsite is a stockpile or crib 13.1 The material is completely covered or open only at the working face Yes No N/A 13.2 The covering material and seams, if any, are water tight Yes No N/A 13.3 The cover is sufficiently secured with weights or tied down Yes No N/A

14. Operating practices at this subsite 14.1 Material amount spilled on apron (not from active or recent use) (10’ around base of structure or stockpile)

None Slight Moderate Severe

14.2 Material amount spilled on grounds (not from active or recent use) (10’ to100’ around base of structure or stockpile)

None Slight Moderate Severe

14.3 Salt from runoff is contained within the salt storage area away from open water sources Yes No 14.4 Stored material is effectively protected from the elements Yes No N/A

14.5 Monthly material inventory records are available for this subsite Yes No Unknown

15. Inspector notes: (Use reverse side if necessary) Reverse side used