NCG030531_MONITORING INFO_20191101

STORMWATER DIVISION CODING SHEET ,
NCG PERMITS
PERMIT NO.
Iv U& L)3L) 3l
DOC TYPE.
❑ HISTORICAL FILE
[IN MONITORING REPORTS
DOC DATE
0
YYYYMMDD

KINGS MOUNTAIN
dIBNN:a.Yr0NA6L
1755 S. Battleground Avenue, Kings Mountain, NC 28086 USA
Tel: [phone] • Fax: [phone] • wvvw.kmiinc.net • email: [e-mail]
October 28, 2019
Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RECEIVED
NOV 0, 20»
CENTRAL Hi_E;
DN P ; i-CT1OtJ
Re: Request for Metals Exemption and Submission of October 2019 Monthly Stormwater Discharge
Monitoring Report Kings Mountain International, Inc.
General Permit NCG030000 - Certificate of Coverage NCG030531
Dear Stormwater Permitting Unit:
Attached please find one original and one copy of the Stormwater Discharge Monitoring Report for Kings
Mountain International, Inc., under General Permit number NCG030000. This submission is for
stormwater discharge sampling performed during the Tier 3 sample collected for the month of October
2019.
Kings Mountain International, Inc. elects to employ the TTO sampling waiver. In compliance with the
waiver, we provide the following signed certification statement on this discharge monitoring report.
"Based on my inquiry of the person or persons directly responsible for managing compliance with the
permit monitoring requirement for Total Toxic Organics (TTO), 1 certify that to the best of my knowledge
and belief, no leak, spill, or dumping of concentrated toxic organics into the stormwater or onto areas which
are exposed to rainfall or stormwater runoff has occurred since the filing of the last discharge monitoring
report. I further certify that this facility is implementing all the provisions of the Solvent Management Plan
included in the Stormwater Pollution Prevention Plan."
If you have any questions regarding this Stormwater Discharge Outfall (SDO) Monitoring Report, please
contact me at your convenience.
Sincerely,
Don Jongs, Vice President of Operations
Kings Mauntain International, Inc.
Enclosures: Stormwater Discharge Monitoring Report, Qualitative Monitoring, Pace Analytical Report

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 10/28/19
CERTIFICATE OF COVERAGE NO. NCG030000
FACILITY NAME Kings Mountain Internaional, Inc.
COUNTY Cleveland
PERSON COLLECTING SAMPLES Don Jones
LABORATORY Pace Labs Lab Cert. # 12 & 40 Comments on
sample collection or analysis: Don Jones
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2019
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly'
DISCHARGING TO CLASS
❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow [:]Watersupply ❑SA
®Other Stormwater
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
F71 No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,.
Inches;
Total Suspended Solids
pH
Standard units
Copper
Lead
Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organics5
'Benchmarks ===>
-
-
100 mg/L or 50 mg/L4
6.0 —9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
SOO #005
10/16/19
1.00
7.01
.0023
.039
1.6j
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outtall.
' For sampling periods with no discharge at any single outtall, you must still submit this discharge monitoring report with a checkmark here.
'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors; manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
.Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Name (Print name)
UL L., I & �uls
Title Print tit'
(Signature)
(Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format, "<XX me/L", where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L'
6.0 — 9.0 SU
Footnotes from Part A also apply to this Part B
' See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: il/l/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. see General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT NAME: Zahid Khan
Mail an oriainal and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring period
in the case of "No Discharge" reports/ to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there 4 significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Date)
Permit Date:11/1/2012-10/31/2017
SWU-245, last revised 10/25/2012
Page 3 of 3

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sxwpsceleoscwn
October 24, 2019
Donna Goins
Kings Mountain International
1755 S Battleground Ave
Kings Mountain, NC 28086
RE: Project: KMI STORMWATER
Pace Project Ni 92450304
Dear Donna Goins:
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, 128078
[phone]
Enclosed are the analytical results for sample(s) received by the laboratory on October 18, 2019.
The results relate only to the samples included in this report. Results reported herein conform to the
most current, applicable TNIINELAC standards and the laboratory's Quality Assurance Manual,
where applicable, unless otherwise noted in the body of the report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
'2�r -tee
Taylor Ezell
[e-mail]
[phone]
Project Manager
Enclosures
cc: Mr. Ivan Cooper, Kings Mountain International
Don Jones, Kings Mountain International
Ryan Wagenknight
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 13

laceAnalyticalo
imcpacefees.cnre
Project: KMI STORMWATER
Pace Project No.: 92450304
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
Louisiana/NELAP Certification # LA170028
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
Asheville Certification IDs
CERTIFICATIONS
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Vrginia/VELAP Certification #: 460221
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
2225 Riverside Drive, Asheville, NC 28804
North Carolina Wastewater Certification #: 40
Florida/NELAP Certification #: E87648
South Carolina Certification #: 99030001
Massachusetts Certification #: M-NC030
VirginiaNELAP Certification #: 460222
North Carolina Drinking Water Certification #: 37712
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 2 of 13

(�IaceAnalytical*
wwwpeceWes.corn
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NO 28078
[phone]
�-M 1W I 11M,d
Project: KMI STORMWATER
Pace Project No.: 92450304
Lab ID Sample ID Matrix Date Collected Date Received
92450304001 SDO#005 Water 10/16/1907:45 10/18/1911:25
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 3 of 13

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w pacelebsc«n
SAMPLE ANALYTE COUNT
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project:
Pace Project No.:
KMI STORMWATER
92450304
Analytes
Lab ID
SamplelD
Method
Analysts
Reported
Laboratory
92450304001
SDO #005
EPA 1664E
JDL
1
PASI-C
EPA 200.7 Rev 4.41994
SH1
3
PASI-A
SM 2540D-2011
MDW
1
PASI-A
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services, LLC. Page 4 of 13

(�IaceAnalytical e
~pacelabs.cnm
ANALYTICAL RESULTS
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: KMI STORMWATER
Pace Project No.: 92450304
Sample: SDO #005
Lab ID: 92450304001 Collected:
10/16/19 07:45
Received: 10/18/19 11:25 Matrix: Water
Report
Parameters
Results Units Limit
MDL DF
Prepared Analyzed CAS No. Oual
HEM, Oil and Grease
Analytical Method: EPA 16648
Oil and Grease
11.6.1 mg/L 5.0
1.3 1
10/24/19 09:50
200.7 MET ICP
Analytical Method: EPA 200.7 Rev 4.4
1994 Preparation
Method : EPA 200.7 Rev 4.4 1994
Copper
0.0023J mg/L 0.0050
0.0021 1
10/21/1923:05 10/23/1901:42 7440-50-8
Lead
ND mg/L 0.0050
0,0016 1
10/21/19 23:05 10/23/19 01:42 7439-92-1
Zinc
0.039 mg/L 0.010
0.0039 1
10/21/19 23:05 10/23/19 01:42 7440-66-6
2540D Total Suspended Solids
Analytical Method: SM 25400-2011
Total Suspended Solids
NO mg/L 2.5
2.5 1
10/22/19 22:08
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10/24/2019 03:39 PM without the written consent of Pace Analytical Services, LLC. Page 5 of 13

aceAnalytical®
~pecelebs.com
QUALITY CONTROL DATA
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
HunterwIle, NC 28078
[phone]
Project: KMI STORMWATER
Pace Project No.: 92450304
QC Batch: 505484
Analysis Method:
EPA 1664E
QC Batch Method: EPA 166413
Analysis Description:
1664 HEM, Oil and Grease
Associated Lab Samples: 92450304001
METHOD BLANK: 2715556
Matrix: Water
Associated Lab Samples: 92450304001
Blank Reporting
Parameter
Units
Result Limit
MDL
Analyzed
Qualifiers
Oil and Grease
mg/L
NO 5.0
1.3
10/24/19 09:47
LABORATORY CONTROL SAMPLE: 2715557
Spike LCS
LCS
%Rec
Parameter
Units
Conc. Result
%Rec
Limits Qualifiers
Oil and Grease
mg/L
40 38.1
95
78-114
MATRIX SPIKE SAMPLE: 2715558
92449798001 Spike
MS
MS
% Rec
Parameter
Units
Result Conc.
Result
%Rec
Limits Qualifiers
Oil and Grease
mg/L
NO 40
11.5
23
78-114 M7
Results presented on this page are In the units Indicated by the "Units" column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10/24/2019 03:39 PM without the written consent of Pace Analytical Services, LLC. Page 6 of 13

m
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.rescelabsco/n
QUALITY CONTROL DATA
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Humersville, NC 28078
[phone]
Project:
KMI STORMWATER
Pace Project No.:
92450304
QC Batch:
504867 Analysis Method: EPA 200.7 Rev 4.4 1994
QC Batch Method:
EPA 200.7 Rev 4.4 1994 Analysis Description: 200.7 MET
Associated Lab Samples:
92450304001
METHOD BLANK: 2712961
Associated Lab Samples: 92450304001
Matrix: Water
Blank
Reporting
Parameter
Units
Result
Limit
MDL
Analyzed Qualifiers
Copper
mg/L
ND 0.0050
0.0021
10/23/19 00:45
Lead
mg/L
ND 0.0050
0.0016
10/23/19 00:45
Zinc
mg/L
ND 0.010
0.0039
10/23/19 00:45
LABORATORY CONTROL SAMPLE:
2712962
Spike
LCS
LCS
% Rec
Parameter
Units
Conc.
Result
%Rec
Limits Qualifiers
Copper
mg/L
0.5
0.46
93
85-115
Lead
mg/L
0.5
0.45
90
85-115
Zinc
mg/L
0.5
0.43
87
85-115
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2712963
2712964
MS
MSD
92449445001
Spike
Spike
MS
MSD
MS
MSD
%Rec
Max
Parameter
Units
Result
Conc.
Conc.
Result
Result
e/ Rec
% Rec
Limits
RPD RPD Qual
Copper
mg/L
41.0 ug/L
0.5
0.5
0.54
0.54
101
100
70-130
1 20
Lead
mg/L
ND
0.5
0.5
0.48
0.48
95
95
70-130
0 20
Zinc
mg/L
116 ug/L
0.5
0.5
0.58
0.58
93
93
70-130
0 20
MATRIX SPIKE & MATRIX SPIKE DUPLICATE: 2712965
2712966
MS
MSD
92450317001
Spike
Spike
MS
MSD
MS
MSD
e/ Rec
Max
Parameter
Units
Result
Conc.
Conc.
Result
Result
%Rec
%Rec
Limits
RPD RPD Qual
Copper
mg/L
ND
0.5
0.5
0.48
0.49
96
97
70-130
1 20
Lead
mg/L
NO
0.5
0.5
0.47
0.48
94
95
70-130
1 20
Zinc
mg/L
ND
0.5
0.5
0.46
0.47
93
94
70-130
1 20
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10/24/2019 03:39 PM without the written consent of Pace Analytical Services, LLC.
Page 7 of 13

aceAnalytical
wwwpacelebs.mm
QUALITY CONTROL DATA
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Hunlersville, NC 28078
[phone]
Project: KMI STORMWATER
Pace Project No.: 92450304
OC Batch: 505072
Analysis Method:
SM 2540D-2011
OC Batch Method: SM 2540D-2011
Analysis Description:
2540D Total Suspended Solids
Associated Lab Samples: 92450304001
METHOD BLANK: 2713919
Matrix:
Water
Associated Lab Samples: 92450304001
Blank
Reporting
Parameter
Units
Result
Limit
MDL Analyzed Qualifiers
Total Suspended Solids
mg/L
NO
2.5 2.5 10/22/19 22:08
LABORATORY CONTROL SAMPLE: 2713920
Spike
LCS
LCS %Rec
Parameter
Units
Conc.
Result
e/ Rec Limits Qualifiers
Total Suspended Solids
mg/L
250
234
94 90-110
SAMPLE DUPLICATE: 2713921
92450377001
Dup
Max
Parameter
Units
Result
Result
RPD RPD Qualifiers
Total Suspended Solids
mg/L
200
203 1 25
SAMPLE DUPLICATE: 2713922
92450130001
Cup
Max
Parameter
Units
Result
Result
RPD RPD Qualifiers
Total Suspended Solids
mg/L
116
120 3 25
Results presented on this page are In the units indicated by the "Units' column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Dale: 10/24/2019 03:39 PM without the written consent of Pace Analytical Services, LLC.
Page 8 of 13

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eww.pecelaes.corn
QUALIFIERS
Project: KM STORMWATER
Pace Project No.: 92450304
l]4y19Y111"I ".
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntemville, NC 28078
[phone]
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND - Not Detected at or above adjusted reporting limit.
TNTC - Too Numerous To Count
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MOIL -Adjusted Method Detection Limit.
PQL- Practical Quantitation Limit.
RL - Reporting Limit - The lowest concentration value that meets project requirements for quantitative data with known precision and
bias for a specific analyte in a specific matrix.
S - Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is
a combined concentration.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(0) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI - The NELAC Institute.
LABORATORIES
PASI-A Pace Analytical Services - Asheville
PASI-C Pace Analytical Services - Charlotte
ANALYTE QUALIFIERS
MI Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample (LCS) recovery.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 10/24/2019 03:39 PM without the written consent of Pace Analytical Services, L-C. Page 9 of 13

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QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: KMI STORMWATER
Pace Project No.: 92450304
Lab ID
Sample ID
QC Batch Method
QC Batch
92450304001
SDO #005
EPA 1664E
505484
92450304001
SDO #005
EPA 200.7 Rev 4.4 1994
504867
92450304001
SDO #005
SM 2540D-2011
505072
Date: 10/24/2019 03:39 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Analytical
Analytical Method Batch
EPA 200.7 Rev 4.4 1994 504889
Page 10 of 13

Document Name:
Document Revised: February 7, 2018
aceMalytiral,
Sample Condition Upon Recelpt(SCUR)
Page 1 of 2
Document No.:
Issuing Authority:
9•CAR-CS-033-Rev.06
Pace Carolinas Quality Office
Laboratory receiving samples:
Asheville ❑ Eden❑ Greenwood ❑ Huntersville []� Raleigh[] Mechanicsville[]
Client Name: /�WO# : 92450304
Courier, ❑Fed Ea ❑UPSUPS n{JSPS i—iClient
❑ Commercial i©Pace []Other:_ 92450304
Custody Seal Present/ ❑Yes ❑ No SealsintactT Yes ,❑No Date/Initials Person faamining Cpmenn: %C`t —zo),—, y
Packing Material: []Bubble Wrap ,❑Q Bubble Bags ❑None ❑ Other Biological Tissue Frozen?
Thermometer:'' Type of Ice: ❑wet naive ❑none '❑yes ❑No.,aN/A
922
,j]IR Gun ID: T/O49
Cooler Temp('C): s L Correction Factor: Add/Subtract ('C) 0.0
Temp should he above freezing to 6'C
Cooler Temp Corrected CC): S J` []Samples out of temp criteria. Samples on ice. cooling process
hasbegun
USDA Regulated Soil (;]-N'JA, water sample)
Did samples originate In a quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (internationally,
mv„. r7m,. Inciudine Hawaii and Puerto Rico)?❑Yes []No
Comments/Discrepancy:
Chain of Custody Present?
ETYe,
ONO
N/A
1.
Samples Arrived within Hold Time?
es
ONO
N/A
2. -
Short Hold Time Analysls(c72hr.)7
❑Yes
N
N/A
3.
Rush Turn Around Time Requested?
OYes
12fro
❑N/A
4.
Sufficient Volume?
11
ONO
?:/A
S.
Correct Containers Used?
.[wa
Ix,
[]No
❑N/A
6.
-Pace Containers Used?
Yeses
,
Na
N/A
'
Containers Intact? _
Yes
No
N/A
7.
Dissolved analysis: Sample.!, Field Filtered? ❑Yes
,❑' No
ONIA
I S. '
Sample Labels Match COC?
❑Yes
2N0
❑N/A
9.
/
dndudes Date/Time/ID/Analysis
rL
Matrix: .V .1/
Heads ace In VOA Was (,S-6mm)?
[]Yes
ONO
N/A
10.
Trip Blank Pretent?
❑Yes
ONO
ON%A
11.
Trip Blank Custody Seals Present?
Yes
No
QN/A
COMMENTS/SAMPLE DISCREPANCY Field Data Required? Oyes ONO
7-^C
'i5 5)6 S?C )5' S�70 LOS
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION _
Person contacted:
Project Manager SCURF Review: IV
Project Manager SRF Review:
Date/Tlme:
Date: D//K
Date:
_Page 11 of 13

Document Name: Document Revised: February 7, 2018
Sample Condition U on Recel t SCUR Page 1 a( 2
i aCB A021}?IC2�� Document No.: Issuing Authority:
F.CAR-CS-03341[ev.06 Pace Carolinas Quality Office
*Check mark top half of box If pH and/or dechlorination is Project A W 0# ' 92450304
verified and within the acceptance range for preservation PM: PTE Due Date: 10/25/19
samples. CLIENT: 92—Kingsiltn
Exceptions: VOA, Ceeform, TOC, Oil and Grease, DRO/8015 (water) DOC, LHg
**Bottomhalf of box is to list number of bottle
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Page 12 of 13

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CHAIN -OF -CUSTODY / Analytical Request Document
The C"in-Of Custody is a LEGAL DOCUMENT. All relevant lields must be compleletl accurately.
N
To
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Page: of
Rest.Section
equiretl Llienl lnfprmalbn: Required Project lnlamalron'. invoice Information'.
Company: Kings Mountain International
Report To: Don Jones
Anivsi . Donna Goins
Address: 1755 South Battleground Ave.
coo, To [e-mail]
Conpany Name: Kings Mountain International, Inc
REGULATORY
AGENCY -
Cleveland, NC 28086
don@kmiinc net
Adaesc.
IR NPDES
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I I— GROUND WATER r, ORINKING WATER
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Email To: [e-mail]
Pwcnaze Order No
Plane: 704-739-4227 Fa.:
Pryor Name: KMI Storm eater
rM^Row° Taylor Ezell
Site Location
N! j
STATE'
NC
Requested Due Date7TAT:
Protect NOmoer:
rntt Prpfdn s: 3729-2
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Environmental
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Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https://deq.nc.gov/about/divisions/energy-mineral-land-
resources/energy-mineral-land-permits Is tormwater- permits/ nodes-industria l-sw#tab-4
Permit No.: N/C/ G/ 0/ 3/ 0/ 0/ 0/ 0/ or Certificate of Coverage No.:
Facility Name: Kings Mountain International. Inc
i
County: Cleveland Phone No. 704-739-4227
Inspector:
Date of Inspection: I 0
Time of Inspection: `i 5 p4 • /V)
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11 Total Event Precipitation (inches):
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DEMLR Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
or Designee)
1. Outfall Description:
Outfall No. 005 Structure (pipe, ditch, etc.): Ditch
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
.. , 1 v
Pagel of 2
SWU-242, Last modified 07/28/2017
;I

2. Color: Describe the color of the
(light, medium, dark) as descriptors:—,
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): A"/&' f P-
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
01 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of Floating solids in
the stormwater discharge, where 1, is no solids and 5 is the surface covered with Floating solids:
C 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
(29 2 3 4 5
7. Is there any foam in the stormwater discharge? o Yes 0"No.
8. Is there an oil sheen in the stormwater discharge? o Yes �KNo.
9. Is there evidence of erosion or deposition at the outfall? g Yes 32(No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe 4&A-
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 07/28/2017

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CHAIN -OF -CUSTODY / Analytical Request Document
The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must he completed accurately.
Section A Section B Section C
Page: of
Required Client Information: Required Project Information', Invoice Information'.
Company: Kings Mountain International Report To: Don Jones Altention: Donna Gains
Address: 1755 South Battleground Ave.
Copy To: '[e-mail]
Company Name'. Kings Mountain International, Inc
REGULATORY AGENCY,-
. _t _
Cleveland, NC 28086
[e-mail]
Addreas'.
N NPDES I GROUND WATER Il DRINKING WATER
I-- UST IRCRA I I OTHER
Email To [e-mail] Purchase
Order NO.:
Pace Dwte
Ruler
Phone: [phone]
Fas: Project
Name: KMI Stonttwater
idea Taylor Ezell
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Site Location
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STATE:
NC
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Requested Due DateRAT: Project
Number:
P P Ide N: 3729-2
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