NC0030848_202303CEI_20230331

DocuSign Envelope ID: 1385DE46-4C5F-4CCE-BFAC-9DCA6CB9B972
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 1 2 u 3 I NC0030848 111 121 23/03/31 I17 18 I C I 19 Ls_] 201 I
211111 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 71 I 74 79 I I I I I I I80
701 I 71 I LL J 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:OOAM 23/03/31
22/09/01
Jefferson Apparel Company WWTP
Greensboro Manufacturing Rd
Exit Time/Date
Permit Expiration Date
Jefferson NC 28640
10:OOAM 23/03/31
26/03/31
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
James Vannoy,PO Box 635 Jefferson NC 286400635//336-846-7191/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit
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
Tricia Lowery DWR/WSRO WQ/336-776-9691/
Docusi9ned by: 3/31/2023
Signature 9� Mina�e��nyent Q A Reviewer Agency/Office/Phone and Fax Numbers Date
T. 15 ,,dcr 4/4/2023
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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DocuSign Envelope ID: 1385DE46-4C5F-4CCE-BFAC-9DCA6CB9B972
NPDES yr/mo/day Inspection Type
NCO030848 I11 12I 23/03/31 117 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Tricia Lowery spoke with John Maloney on 3/31/2023. The facility is not in operation and no
discharge coming from facility. The owner is keeping permit active for future plans. Once facility is in
operation, a comprehensive compliance evaluation inspection will be conducted.
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DocuSign Envelope ID: 1385DE46-4C5F-4CCE-BFAC-9DCA6CB9B972
Permit: NC0030848
Inspection Date: 03/31/2023
Owner -Facility: Jefferson Apparel Company WWTP
Inspection Type: Compliance Evaluation
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted a new
application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Yes No NA NE
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Comment: This facility is not in operation, therefore no discharge. They are keeping permit active
for future plans.
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