NCG510516_EPA Report for White's Grocery Inspection_20190425

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 I 2 15 I 3 I NCG510516 111 12 I 19/04/04 I17
18 I S J 19 L G] 201 I
211111 1 1 I I I I II I I I I I I I I I I I I 1 I I I I
I I I I I I II I I I I I f6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating 131 QA
---------------------- Reserved -------------------
671
70 I5 71 I tyI 72 I r I
uI
73 I I 174 751 I I I I I I I80
I I i
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 oermit Number)
10:OOAM 19/04/04
16/11/07
White's Grocery
7296 NC Hwy 65
Exit Time/Date
Permit Expiration Date
Belews Creek NC 27009
11:20PM 19/04/04
20/09/30
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
Nadia White,7296 Hwy 65 Belews Creek NC 27009//336-595-4622/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Operations & Maintenance 0 Facility Site Review 0 Effluent/Receiving Waters
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
Jim J Gonsiewski Docusigned by: Division of Water Quality//336-776-9704)
QoVw-
4/25/2019
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Signature of Management Q A RBo ugb g ed by: Agency/Office/Phone and Fax Numbers
Date
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4/25/2019
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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NPDES yr/mo/day Inspection Type
NCG510516 I11 121 19/04/04 117 18 JCJ
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
The groundwater remediation system at the facility has not been in operation since April 2016 due to
limited funding from the UST Trust Fund. Prior to restarting the remediation system and discharging
treated groundwater to the surface waters of the State, please notify the DEQ Winston-Salem Regional
Office.
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Permit: NCG510516
Inspection Date: 04/04/2019
Owner - Facility: white's Grocery
Inspection Type: Compliance Evaluation
Operations & Maintenance
Is the plant generally clean with acceptable housekeeping?
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment:
Yes No NA NE
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