WQCSD0200_Compliance Evaluation Inspection_20190801

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPE .
Director
Joseph R. Pearce
Aqua North Carolina, Inc.
202 Mackenan Court
Cary, NC 27511
NORTH CAROLINA
Environmental Quality
August 1, 2019
Subject: Deemed Permitted Wastewater Collection System Inspection Reports
System Numbers WQCSD0187, WQCSD0194, and WQCSD0200
Frye Bridge, Forest Ridge, and Salem Glen Collection Systems, Respectively
Davidson and Forsyth Counties
Dear Mr. Pearce:
RECEIVED/NCDEQ11)"
AUG 0 8 2019
Water Quality
Permitting Section
On June 27, 2019, Paul DiMatteo of the Division of Water Resources (Division), Winston-Salem Regional Office
met with Samuel Pegram to conduct Compliance Evaluation Inspections of the above referenced Deemed Permitted
Wastewater Collection Systems.
The inspections consist of (1) a review of the permit and accompanying documentation to determine
compliance with permit conditions, and (2) an on -site inspection of several collection system components. The
attached inspection form notes the areas that were evaluated for the inspection, with notable findings
outlined as follows.
Site Inspections
I. Frye Bridge —The main pump station and a manhole near that pump station were inspected. No issues were
noted.
2. Salem Glen —The Keswick Lane and Hamptons pump stations were inspected, as well as a manhole on Hampton
Oak Court. No issues were noted.
Permit Conditions
1. We recommend updating the collection system map to include pipe sizes, materials and age.
NORiH CARD! INA� � � !'
oraam�®�meow�r�
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road, Suite 3001 Winston-Salem, North Carolina 27105
336.776.9800

The inspections were considered satisfactory. If you should have any questions, please do not hesitate to
contact Paul DiMatteo at [phone] or our office at [phone].
Sincerely,
DocuSlgned by:
145B49EMC94EA
Lon T. Snider, Regional Supervisor
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
Enclosures — Inspection Reports
CC: WQS Winston-Salem Regional Office
PERCS Unit
Central Files

Compliance Inspection Report
Permit: WQCSDO187 Effective: 03/01/00 Expiration: Owner : Aqua North Carolina Inc
SOC: Effective: Expiration: Facility: Frye Bridge Collection System
County: Forsyth
Region: Winston-Salem
Contact Person: Joseph R Pearce Title: Director of Operations Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s).
Related Permits:
Inspection Date: 06/27/2019 Entry Time: 10 25AM Exit Time: 10 55AM
Primary Inspector: Paul DiMatteo Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Collection System Inspect Non Sampling
Permit Inspection Type: Deemed permitted collection system management and operation
Facility Status: Compliant ❑ Not Compliant
Question Areas:
■ Miscellaneous Questions General Grease Control
Spills/Response Plan Inspections Manholes
Pump Stations
(See attachment summary)
Page 1 of 6

Permit: WQCSD0187 Owner- Facility: Aqua North Carolina Inc
Inspection Date 06/27/2019 Inspection Type : Collection System Inspect Non Sampling Reason for Visit. Routine
Inspection Summary
Page 2 of 6

Permit: WQCSD0187 Owner - Facility: Aqua North Carolina Inc
Inspection Date, 06/27/2019 Inspection Type : Collection System Inspect Non Sampling Reason for Visit: Routine
General
# Is this system a satellite system?
# If Yes, what is system name or permit number?
Is there a overall sewer system map?
Does the map include
Pipe sizes
Pipe materials (PVC, DIP, etc)
Pipe location
# Flow direction
# Approximate pipe age
# Pump station ID, location and capacity
# Force main air release valve location & type
# Location of satellite connections
Are system maintenance records maintained?
Comment Collection system map has locations only
Grease Control
Is grease/sewer education program documented with req'd customer distribution?
# Are other types of education tools used like websites, booths, special meetings, etc?
If Yes, what are they? (This can reduce mailing to annual )
For public systems, is there a Grease Control Program via an ordinance/agreement?
If Yes, does it require grease control devices at applicable locations?
Is the Grease Control Program enforced via periodic inspections/records review?
Is action taken against violators?
Comment
Spills and Response Action Plan
# Is system free of known points of bypass?
If No, describe type of bypass and location
# Have there been any sewer spills in the past 3 years?
If Yes, were they reported to the Division if meeting the reportable criteria?
If applicable, is there documentation of press releases and public notices issued?
Are all spills or sewer related issues/complaints documented?
# Are there repeated overflows/problems (2 or more in 12 months) at same location?
# If Yes, is there a corrective action plan?
Is a Spill Response Action Plan available?
Is a Spill Response Action Plan available for all personnel?
Yes No NA NE
❑■❑❑
■❑❑❑
Yes No NA NE
Yes No NA NE
■❑❑❑
❑■❑❑
❑❑■❑
❑ ❑ ❑
❑❑■❑
❑❑■❑
❑❑■❑
■❑❑❑
■❑❑❑
Page 3 of 6

Permit: WQCSD0187 Owner -Facility. Aqua North Carolina Inc
Inspection Date: 06/27/2019 Inspection Type . Collection System Inspect Non Sampling
Reason for Visit: Routine
Does the plan include
# 24-hour contact numbers
❑ ❑ ❑
# Response time
0 ❑ ❑ ❑
# Equipment list and spare parts inventory
0 ❑ ❑ ❑
# Access to cleaning equipment
N ❑ ❑ ❑
# Access to construction crews, contractors, and/or engineers
0 ❑ ❑ ❑
# Source of emergency funds
❑ ❑ 0 ❑
# Site sanitation and cleanup materials
E ❑ ❑ ❑
# Post-overflow/spill assessment
E ❑ ❑ ❑
Comment
Inspections Yes No NA NE
Are adequate maintenance records maintained? E ❑ ❑ ❑
Are pump stations being inspected at the required frequency? 0 ❑ ❑ ❑
Is at least one complete functionality test conducted weekly per pump station? 0 ❑ ❑ ❑
Is there a system or plan in place to observe the entire system annually? 0 ❑ ❑ ❑
Is the annual inspection documented? 0 ❑ ❑ ❑
# Does the system have any high -priority Imes/locations? ❑ E ❑ ❑
Are inspections of HPL documented at least every 6 months? ❑ ❑ 0 ❑
Are new lines being added to the HPL list when found or created? 0 ❑ ❑ ❑
Comment
Manholes
Yes No NA NE
Please list the Manholes Inspected
Manhole outside PS
Are manholes accessible?
E ❑ ❑ ❑
# Are manhole covers/vents above grade?
E ❑ ❑ ❑
Are manholes free of visible signs of overflow?
0 ❑ ❑ ❑
Are manholes free of sinkholes and depressions?
❑ ❑ ❑
Are manhole covers present?
❑ ❑ ❑
# Are manholes properly seated?
E ❑ ❑ ❑
# Are manholes in good condition?
❑ ❑ ❑
# Are inverts In good condition?
❑ ❑ ❑
Is flow unrestricted in manholes?
❑ ❑ ❑
Are manholes free of excessive amounts of grease?
❑ ❑ ❑
Are manholes free of excessive roots?
0 ❑ ❑ ❑
Are manholes free of excessive sand?
0 ❑ ❑ ❑
Are manhole vents screened?
❑ ❑ 0 ❑
Page 4 of 6

9 4o 9 e6ed
❑ m ❑ ❑
Lsdwnd xaldwls;uawa0eldaJ;o o6e;ua0Jad panoJdde 94; ane4 aa;;lwJad Sao(] #
LUeld w papnl0ul aJe (0;a/salolga^gms/s;lu(]) saoJnosaJ;e4M'saA;l
❑ ❑ ❑ ■
Lueld uol;nqu;slp a aJa4; s1 'sa,k dl #
❑ ❑ ❑ 0
Labe;no Jannod a 10;uana 94; ul s;1un alge}Jod uo 6uiAlaJ Jaunno a4; sl #
❑ ❑ ❑ M
LJo;eJauab alge}Jod a Jo} U01109000O pa;eolpap a ane4;1 Sao(] #
❑ 0 ❑ Fl
Lsuol;lpuoo 6u1;eJado IewJou Japun AIlenuue-1q;seal;e pa;se; wa;sAs do-Noeq a4; SI
❑ m ❑ ❑
e AliedoJd uogoun};1 pip 'uogoodsul 6uunp pa;sa; 11
❑ ❑ . ❑
Lpa;oauuoo dwnd ssedAq Jo Jo;eJaua6 dnNoeq a aJa4; sl #
El 11 ❑ M
e elgeJado swJele lensln pue olpne aJy
❑ El ❑ 0
L;uesaJd swJele lensln pue olpne aJy
❑ ❑ 0 ■
LsJagwnu;oe;uoo Aoua6Jawo Jno4-17Z
❑ ❑ ❑ ■
6U01;e0glj0U J0; SU0113fu;SUI
❑ ❑ ■ ❑
LSSaJPPV #
❑ ❑ ❑ ■
LJayl;uapl uol;e;s dwnd
El El El ■
LaweN JaumO
apnloul u61s a4; sao(]
❑
L pa;sod u61s uol;eogl;ou Jno4-tiZ a sl
❑ ❑ ❑ 0
Lleuol;oun; wa;sAs ti;awala; a4; sl
❑ ❑ ❑ 0
LPalle;sul kjGU.lala; ane4 Ile Aa41 O(] #
❑ ❑
Lsugap/aseaJ6 anlssa0x9 10 aaJ) sllaM;aM aJaM
❑ ■
Lsadld/saJn;onJ;s ssed-Aq }o aai; Aa4; aJaM
❑ ❑ ❑ ■
Lssaooe pa;oulsaJ 4;1M aJnoes Aa4; aJy
pa;oadsul suol;e;s dwnd Jod
;
LPalle;sul (Jalelp-o;ne) wa;sf(s uogeownwwoo//i;awela; AeM-auo aldwls y #
0
LPalle;sul (y(]y(]S) wa;sAs uol;eownwwoo „bulllod o;ne„ AeM-oM; y #
ane4 suol;e;s wnnoen/dwnd Auew MOH
0
6ulppnq auo ue4; aJow 6uuuas wa;sAs ul suol;e;s dwnd xaldwls;o JagwnN #
0
wa;sAs ul suol;e;s dwnd xeldwls;o JagwnN #
0
wa;sAs ul suol;e;s wnnoen;o JagwnN #
wa;sfis u1 suol;e;s dwnd Ja6Jel Jo xaldnp;o JagwnN #
a6pug ak-4
pa;oadsul suol;e;S dwnd a4;;s11 aseald
3N `dN ON saA
suo!le4S dwnd
}uawwoo
❑ ❑ ❑ 0
Lsadld Jo saJn;onJ;s ssedAq }o aaJ} saloquew aJy
❑ ■
e eoua6Jawgns;o 90JI s;uan aJy
eullnoa :MSIAJo; UOSIRG l
bulldweS uoN;3adsul wa;sAS uoi;oalloo edA.L uogoadsul 6WZ/LZ/90 •a;eCl uol;oadsul
oul eugoJeO glJON enbV AIRoe3 - J8um0 L9104S010M :VwJad

Permit: WQCSD0187 Owner -Facility: Aqua North Carolina Inc
Inspection Date: 06/27/2019 Inspection Type : Collection System Inspect Non Sampling Reason for Visit: Routine
Is recordkeeping of pump station inspection and maintenance program adequate?
Do pump station logs Include at a minimum
Inside and outside cleaning and debris removal?
Inspecting and exercising all valves?
Inspecting and lubricating pumps and other equipment?
Inspecting alarms, telemetry and auxiliary equipment?
Comment Inspection logs Include Initial/date and any actions performed that day
❑❑■❑
❑❑❑■
❑❑❑■
❑ ❑ ❑
❑ ❑ ❑ E
Page 6 of 6

Compliance Inspection ReDOrt
Permit: WQCSDO194 Effective: 03/01/00 Expiration: Owner : Aqua North Carolina Inc
SOC: Effective: Expiration: Facility: Salem Glen Subdivision Collection System
County: Davidson
Region: Weston -Salem
Contact Person: Joseph R Pearce Title: Director of Operations Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 06/27/2019
Primary Inspector: Paul DiMatteo
Secondary Inspector(s):
Certification:
Phone:
Entry Time: 09 10AM Exit Time: 10 25AM
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Collection System Inspect Non Sampling
Permit Inspection Type: Deemed permitted collection system management and operation
Facility Status: Compliant ❑ Not Compliant
Question Areas:
Miscellaneous Questions General Grease Control
Spills/Response Plan Inspections Manholes
Pump Stations
(See attachment summary)
VA
Page 1 of 6

Permit: WQCSD0194 Owner- Facility: Aqua North Carolina Inc
Inspection Date: 06/27/2019 Inspection Type . Collection System Inspect Non Sampling Reason for Visit: Routine
Inspection Summary
Page 2 of 6

Permit: WQCSD0194 Owner - Facility: Aqua North Carolina Inc
Inspection Date: 06/27/2019 Inspection Type . Collection System Inspect Non Sampling Reason for Visit: Routine
General
# Is this system a satellite system?
# If Yes, what is system name or permit number?
Is there a overall sewer system map?
Does the map include
Pipe sizes
Pipe materials (PVC, DIP, etc)
Pipe location
# Flow direction
# Approximate pipe age
# Pump station ID, location and capacity
# Force main air release valve location & type
# Location of satellite connections
Are system maintenance records maintained?
Comment Map includes line locations only
Grease Control
Is grease/sewer education program documented with req'd customer distribution?
# Are other types of education tools used like websites, booths, special meetings, etc?
If Yes, what are they? (This can reduce mailing to annual )
For public systems, is there a Grease Control Program via an ordinance/agreement?
If Yes, does it require grease control devices at applicable locations?
Is the Grease Control Program enforced via periodic inspections/records review?
Is action taken against violators?
Comment.
Spills and Response Action Plan
# Is system free of known points of bypass?
If No, describe type of bypass and location
# Have there been any sewer spills in the past 3 years?
If Yes, were they reported to the Division if meeting the reportable criteria?
If applicable, is there documentation of press releases and public notices issued?
Are all spills or sewer related issues/complaints documented?
# Are there repeated overflows/problems (2 or more in 12 months) at same location?
# If Yes, is there a corrective action plan?
Is a Spill Response Action Plan available?
Is a Spill Response Action Plan available for all personnel?
Yes No NA NE
❑■❑❑
1010101
❑ M ❑ ❑
❑ E ❑ ❑
• ❑ ❑ ❑
• ❑ ❑ ❑
❑ M ❑ ❑
■❑❑❑
❑ M ❑ ❑
❑❑■❑
❑ E ❑ ❑
Yes No NA NE
❑❑❑■
❑ ❑ ❑
❑❑■❑
❑ ❑ MEI
❑ ❑ M ❑
❑ ❑ M ❑
Yes No NA NE
❑ ❑ ❑
❑■❑❑
❑ ❑ E ❑
❑ ❑ M ❑
❑ ❑ ❑
❑■❑❑
❑ ❑ M ❑
❑ ❑ ❑
Page 3 of 6

Permit: WQCSDO194 Owner - Facility Aqua North Carolina Inc
Inspection Date 06/27/2019 Inspection Type . Collection System Inspect Non Sampling Reason for Visit: Routine
Does the plan Include
# 24-hour contact numbers
# Response time
# Equipment list and spare parts inventory
# Access to cleaning equipment
# Access to construction crews; contractors, and/or engineers
# Source of emergency funds
# Site sanitation and cleanup materials
# Post-overflow/spill assessment
Comment
Inspections
Are adequate maintenance records maintained?
Are pump stations being Inspected at the required frequency?
Is at least one complete functionality test conducted weekly per pump station?
Is there a system or plan In place to observe the entire system annually?
Is the annual Inspection documented?
# Does the system have any high -priority Imes/locations?
Are inspections of HPL documented at least every 6 months?
Are new Imes being added to the HPL list when found or created?
Comment
Manholes
Please list the Manholes Inspected
Manhole on Hampton Oak Court
Are manholes accessible?
# Are manhole covers/vents above grade?
Are manholes free of visible signs of overflow?
Are manholes free of sinkholes and depressions?
Are manhole covers present?
# Are manholes properly seated?
# Are manholes In good condition?
# Are Inverts In good condition?
Is flow unrestricted In manholes?
Are manholes free of excessive amounts of grease?
Are manholes free of excessive roots?
Are manholes free of excessive sand?
Are manhole vents screened?
■❑❑❑
❑ ❑ ❑
❑ ❑ ❑
■❑❑❑
■❑❑❑
❑ N ❑ ❑
• ❑ ❑ ❑
• ❑ ❑ ❑
Yes No NA NE
■❑❑❑
❑ ❑ ❑
■❑❑❑
Yes No NA NE
❑ ❑ ❑
❑ E ❑ ❑
■❑❑❑
❑ ❑ ❑
❑ ❑ ❑
❑ ❑ ❑
Page 4 of 6

Permit: WQCSDO194 Owner -Facility: Aqua North Carolina Inc
Inspection Date. 06/27/2019 Inspection Type : Collection System Inspect Non Sampling Reason for Visit: Routine
Are vents free of submergence? ❑ ❑ ❑
Are manholes free of bypass structures or pipes? M ❑ ❑ ❑
Comment.
Pump Stations Yes No NA NE
Please list the Pump Stations Inspected
Keswick Lane PS, The Hamptons PS
# Number of duplex or larger pump stations In system 6
# Number of vacuum stations in system 0
# Number of simplex pump stations in system 0
# Number of simplex pump stations In system serving more than one building 0
How many pump/vacuum stations have
# A two-way "auto polling" communication system (SCADA) installed? 0
# A simple one-way telemetry/communication system (auto -dialer) installed? 6
For pump stations inspected
Are they secure with restricted access?
M ❑ ❑ ❑
Were they free of by-pass structures/pipes?
M ❑ ❑ ❑
Were wet wells free of excessive grease/debris?
M ❑ ❑ ❑
# Do they all have telemetry installed?
M ❑ ❑ ❑
Is the telemetry system functional? \
❑ ❑ ❑
Is a 24-hour notification sign posted ?
0 ❑ ❑ ❑
Does the sign include
Owner Name?
❑ ❑ ❑
Pump station Identifier?
0 ❑ ❑ ❑
# Address?
❑ M ❑ ❑
Instructions for notification?
❑ ❑ ❑
24-hour emergency contact numbers?
❑ ❑ ❑
Are audio and visual alarms present?
0 ❑ ❑ ❑
Are audio and visual alarms operable?
0 ❑ ❑ ❑
# Is there a backup generator or bypass pump connected?
❑ El ❑
If tested during inspection, did it function properly?
❑ ❑ E ❑
Is the back-up system tested at least bi-annually under normal operating conditions?
❑ ❑ M ❑
# Does it have a dedicated connection for a portable generator?
0 ❑ ❑ ❑
# Is the owner relying on portable units in the event of a power outage?
❑ ❑ ❑
# If Yes, is there a distribution plan?
❑ ❑ ❑
If Yes, what resources (Units/Staff/Vehicles/etc) are included in Plan?
# Does Permlttee have the approved percentage of replacement simplex pumps?
❑ ❑ M ❑
Page 5 of 6

Permit WQCSD0194 Owner- Facility Aqua North Carolina Inc
Inspection Date: 06/2712019 Inspection Type : Collection System Inspect Non Sampling
Is recordkeeping of pump station inspection and maintenance program adequate?
Do pump station logs include at a minimum
Inside and outside cleaning and debns removal?
Inspecting and exercising all valves?
Inspecting and lubricating pumps and other equipment?
Inspecting alarms, telemetry and auxiliary equipment?
Comment: Pump station lops are adequate
Reason for Visit. Routine
■❑❑❑
❑ ❑ M ❑
❑❑■❑
Page 6 of 6

Compliance Inspection Report
Permit: WQCSD0200 Effective: 03/01/00 Expiration: Owner: Aqua North Carolina Inc
SOC: Effective: Expiration: Facility: Forest Ridge Subdivision Collection System
County: Forsyth
Region: Winston-Salem
Contact Person: Joseph R Pearce Title: Director of Operations Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 06/27/2019
Primary Inspector: Paul DiMatteo
Secondary Inspector(s):
Certification:
Phone:
Entry Time: 11 15AM Exit Time: 11 35AM
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Collection System Inspect Non Sampling
Permit Inspection Type: Deemed permitted collection system management and operation
Facility Status: Compliant ❑ Not Compliant
Question Areas:
Miscellaneous Questions General Grease Control
Spills/Response Plan Inspections
(See attachment summary)
Page 1 of 4

Permit: WQCSD0200 Owner - Facility: Aqua North Carolina Inc
Inspection Date: 06/27/2019 Inspection Type : Collection System Inspect Non Sampling Reason for Visit: Routine
Inspection Summary
The only pump station In this system Is In the wastewater treatment plant
- Page 2 of 4

Permit: WQCSD0200 Owner- Facility: Aqua North Carolina Inc
Inspection Date: 06/27/2019 Inspection Type : Collection System Inspect Non Sampling
Reason for Visit- Routine
General
Yes No NA NE
# Is this system a satellite system?
❑ ❑ ❑
# If Yes, what is system name or permit number?
Is there a overall sewer system map?
❑ ❑ ❑
Does the map include
Pipe sizes
❑ ❑ ❑
Pipe materials (PVC, DIP, etc)
❑ ❑ ❑
Pipe location
❑ ❑ ❑
# Flow direction
0 ❑ ❑ ❑
# Approximate pipe age
❑ 0 ❑ ❑
# Pump station ID, location and capacity
❑ ❑ 0 ❑
# Force main air release valve location & type
❑ ❑ M ❑
# Location of satellite connections
❑ ❑ E ❑
Are system maintenance records maintained?
0 ❑ ❑ ❑
Comment
Grease Control Yes No NA NE
Is grease/sewer education program documented with req'd customer distribution? ❑ ❑ ❑
# Are other types of education tools used like websites, booths, special meetings, etc? ❑ ❑ ❑
If Yes, what are they? (This can reduce mailing to annual.)
For public systems, is there a Grease Control Program via an ordinance/agreement? ❑ ❑ ❑
If Yes, does it require grease control devices at applicable locations? ❑ ❑ M ❑
Is the Grease Control Program enforced via periodic inspections/records review? ❑ 1:10 ❑
Is action taken against violators? ❑ ❑ 0 ❑
Comment: According to the operator AQUA sends grease Info in the bills every 6 months However,
documentation was not available to review during the inspection.
Spills and Response Action Plan
Yes No NA NE
# Is system free of known points of bypass?
❑ ❑ ❑
If No, describe type of bypass and location
# Have there been any sewer spills in the past 3 years?
❑ ❑ ❑
If Yes, were they reported to the Division if meeting the reportable criteria?
❑ ❑ ❑
If applicable, is there documentation of press releases and public notices issued?
❑ ❑ E ❑
Are all spills or sewer related issues/complaints documented?
❑ ❑ 0 ❑
# Are there repeated overnows/problems (2 or more in 12 months) at same location?
❑ ❑ M ❑
# If Yes, is there a corrective action plan?
❑ ❑ ❑
Is a Spill Response Action Plan available?
❑ ❑ ❑
Page 3 of 4

Permit: WQCSD0200 Owner -Facility: Aqua North Carolina Inc
Inspection Date- 06/27/2019 Inspection Type : Collection System Inspect Non Sampling
Is a Spill Response Action Plan available for all personnel?
Does the plan include
# 24-hour contact numbers
# Response time
# Equipment list and spare parts inventory
# Access to cleaning equipment
# Access to construction crews, contractors, and/or engineers
# Source of emergency funds
# Site sanitation and cleanup materials
# Post-overflow/spill assessment
Comment
Inspections
Are adequate maintenance records maintained?
Are pump stations being inspected at the required frequency?
Is at least one complete functionality test conducted weekly per pump station?
Is there a system or plan in place to observe the entire system annually?
Is the annual Inspection documented?
# Does the system have any high-pnonty Imes/locations?
Are inspections of HPL documented at least every 6 months?
Are new lines being added to the HPL list when found or created?
Comment.
Reason for Visit: Routine
■❑❑❑
❑ ❑ ❑
■❑❑❑
• ❑ ❑ ❑
• ❑ ❑ ❑
❑ ❑ ❑
❑❑■❑
❑ ❑ ❑
❑ ❑ ❑
Yes No NA NE
M ❑ ❑ ❑
❑ ❑ ❑
❑ ❑ ❑
❑ ❑ ❑
❑ ❑ ❑
Page 4 of 4