NC0075027_Compliance Inspection NOD2015PC0117_20150518 (2)

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United States Environmental Protection Agency Form Approved.
EPA Washington,D.C.20460 OMB No.2040-0057
I Water Compliance Inspection Report Approval expires B-31-98
Section A:National Data System Coding(i.e.,PCS)
I Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 �N j 2 15 1 3 I NCO075027 111 12 15/05/08 17 18 1,.1 191 G I 201I
2111 1 1 1 11-11 1 1 1 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 I 1 1 1 1 f
Inspection Work Days Facility Self-Monitoring Evaluation Rating 81 QA Reserved-
67 701 I 71 I 72 I N I 731 1 X74 751 I I I I I I 180
LJ 'Section B:Facility-Data
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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:DOAM 15/05/08 12/05/01
Cains Way Mobile Home Park
Pinehall Rd Exit Time/Date Permit Expiration Date
Walkertown NC 27051 10:00AM 15/05/08 17/02/28
Name(s)of Onsite Representative(s)[Titles(s)/Phone and Fax Number(s) Other Facility Data
///
Bradley Todd FtynVORC/336-433-7262/
Name,Address of Responsible OfficiaVTifle/Phone and Fax Number
Contacted
Daryl Cain,PO Box 846 Walkertown NC 270510846111
No
4. 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 BooWSRO WQ//336-778-9890/
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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 ydmo/day Inspection Type 1
31 NC00750! 111 12 15/05/08 17 18 1,1
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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