NC0075027_NOV2016PC053 Site Visit_20160219 (6)

`y 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 H 2 15 I 3 I NCO075027 111 12 1 16/02/10 17 18 19 [ s 201
211111 1 1 1 1 1 111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 111 1 1 1 1 1 166
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA ----------------Reserved-------------
67 70LJ 71 ty] 72 LJ 73I 174 751 1 1 1 1 1 1 80
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 16/02/10 12/05/01
Cains Way Mobile Home Park
Pinehall Rd Exit Time/Date Permit Expiration Date
11 OOAM 16/02/10 17/02/28
Walkertown NC 27051
Name(s)of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data
Bradley Todd Flynt/ORC/336-433-7262/
Name,Address of Responsible Official/Title/Phone and Fax Number
Contacted
Daryl Cain,PO Box 846 Walkertown NC 270510846M
No
Section C-Areas Evaluated During Inspection(Check only those areas evaluated)
® Permit ® Flow Measurement ® Operations&Maintenance ® Records/Reports
Self-Monitoring Program Sludge Handling Disposal ® Facility Site Review ® Effluent/Receiving Waters
Laboratory
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
Ron Boone WSRO WQH336-776-9690/
z/i1j, L
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
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EPA Form 3560-3(Rev 9-94)Previous editions are obsolete
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NPDES yr/mo/day Inspection Type 1
31 NCO075027 I11 12 16/02/10 17 18 1x.1
Section D Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
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