NCG550332_Compliance Evaluation Inspection_20200727

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 NCG550332 111 121 20/07/27 I17 18 I C 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)
09:30AM 20/07/27
19/10/29
5910 Twin Meadows Drive
5910 Twin Meadows Dr
Exit Time/Date
Permit Expiration Date
Pfafftown NC 27040
10:OOAM 20/07/27
20/10/31
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
Richard F Wagner,5910 Twin Meadows Dr Pfafftown NC 27040//336-945-9188/
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
NCG550332 I11 12I 20/07/27 117 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
This was a final inspection for the permit to be resended.
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Permit: NCG550332
Inspection Date: 07/27/2020
Other
Owner -Facility: 5910 Twin Meadows Drive
Inspection Type: Compliance Evaluation
Comment: This was a final inspection for the permit to be resended.
Yes No NA NE
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