NCG551769_Staff Report_20200811

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 IN 2 u 3 I NCG551769 111 121 20/08/11 I17 18 I D I 19 I S I 20L]
21111I I I I I I I II I I I I I I I I I I I I I I I I I I I I I I I II I I I I I r6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA ---------------------- Reserved -------------------
67
I 72 I n, I 73 � I 74 79 I I I I I I I80
70 I I 71 I LL -1 I I
LJ
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:OOAM 20/08/11
1646 NC Highway 80
1646 NC Hwy 801
Exit Time/Date
Permit Expiration Date
Mocksville NC 27028
10:30AM 20/08/11
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Josh Greene,1646 NC Hwy 801 Mocksville NC 27028/Pastor/336-345-3057/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Other
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Gary Hudson DWR/Division of Water Qua Iity/336-776-9694/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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NPDES yr/mo/day Inspection Type
NCG551769 I11 12I 20/08/11 117 18 IDI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
This was a visit for a staff report. Facility not yet built.
Page#

Permit: NCG551769
Inspection Date: 08/11/2020
Other
Comment: This was a visit for a staff report.
Owner -Facility: 1646 NC Highway 80
Inspection Type: Technical Assistance
Yes No NA NE
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