NCS000334_MONITORING INFO_20191230

STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
DOC TYPE
❑FINAL PERMIT
CYMONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
[I OTHER
���I C� � `� 3 �1
DOC DATE
❑
YYYYMMDD

jI
ne Chemicals IrK.
December 20. 2019
�� � y q •. a •� •..
Division of Water Quality
Surface Water Protection Section
Attention: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RF : Stormwater Discharge Oudali 1vionitoring Report
JCI Jones Chemicals, Inc., Charlotte, NC
Permit Number: NCS-000334
Dear Sir or Madam.
Enclosed please find a Stormwater Discharge Outtall (SDO) Monitoring Report (original
and one copy) for the semi-annual period of July 1, 2019 — December 31, 2019 For our
Charlotte. North Carolina Facility.
Please contact nee at [phone] if you have any questions or require additional
information.
Very truly }tours,
JCI Jones Chemicals, Inc.
�J•
'i'i1��n�111� 1, riatFl?f'•�r
1aXCCUiiye Vice President
1",1G:tg
F nCIOSLIre
Cc Mike Croke, JCI — Charlotte, NC
Caledonia Branch • 100 Sunny Sol Blvd. • Caledonia, NY 14423 • relephone: 585.538.2314 • facsimile: 585-338.2316 • 800.2553789
Branch be ranmm • Warwick, NY • Parhernan, OH • River ieu•, \11 • Merrimack,NH • Charlotte, NC • Jacksnm ills, FL
• Beecir Cirove, IN • Milfnnl, VA • T•icoma, WA • Turrancr, CA • Cnjx=e Office Sarasota, FL
www.jcichcnic,als.com

STORMWATER DISCFIARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS 000 3 3
FACILITY ,NAME �l.�.f._ �.J C*% SOXeMi Cqk G
PERSON COLLECTING SAMPLE S) 'V% A
CERTIFIED LABORATORY(S) C (u�o Lab #
C,,,;?6U19 Lab#
Part A: Specific Monitoring Requirements
SA,\1PLES COLLECTED DURING CALENDAR YEAR: 0 2019
(This monitoring report shall be received by the Division no later. than 30 days from
the date the facility, receives the sampling results from the laboratory)
COUNT` MP—C-OeA� i.US
PHONE NO. (7 &J) 3' L— c?-7 to-7
F
NATURE OF PERMITTEE OR DESIGNEE
QUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected
50050 -
Total
Flow if app.)
Total
Rainfall
�v4n
Ss
eRlorC,ne,
-t—les.
—r`p{u{
mo/ddiyr` -
MG
inches
x4% L•
'�vvq, L
rr► L
5. i L°�
Uo 1
Iz is -III
O.S
6 6
L0.01
6.2
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ()yes Ono
(if yes, complete Part B)
Part B: Vehicle ,Maintenance Activity Monitoring Requirements
Outfaw'-
Rate
50050�
.a w.
=0055G
r
00530 F
:00400
!o r
tom.
a
;# �,1 �,; `. �,„„
Sample�a
Collected
,� � � ..
s✓w. w
TotalyyFlow
'(if fipplicable}r
�•
x
�
total
Rainfall
r#
Oil &Grease
(if app1:)
..,,,et urawa'.ei
,ton- olar
O&G/TP,H=
•(h9ethod 1664
Total
'Suspended.W
�
Sotitls'P�sY
- II',1\ewRll7otor
`= 3.,• '
• �r�`���
'Oil+Usa e . A-
k., g
kv
<x
nt l � �•
nj L�cr.r. ): f �
=�`,Ft.Tn ,r..4:r -.Z;~r-
, -
molild/vr
MG' _ �+ :
inches � �:� _��
' m..�€�� ..
►� � ^` �. Via,
:m n� � � ..
Urnt �'� � f t
€_.:al/ino
Form SWU-247, last revised 611 12015
Page I of 2

STORM EVENT CHARACTERISTICS:
Date j-F I
Total Event Precipitation (inches): V 5
Event Duration (hours): (only if applicable —see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable— see permit.)
Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Attn: Central Piles
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
1 Z �Z o/ 2-61 l `�
(Signature of Per to (Date)
Form SWU-247, Iasi revised 611212015
Page 2 of 2

STORM WATER DISCIIARGE 0UTFA1.L (SDO)
MONITORING REPORT
Permit Number NCS L 3
FACILITY NAME
PERSON COLLECTING SAMPLE(S) 'I
CERTIFIED LABORA'I'OR)'(S)Ck, — a..c. (.A(o Lab #
C� JcJ4, Lab#
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 1�2- 014
(This monitoring report shall he received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY W 4-CK lIe A- j U j:j
PHONE NO. i(_ t 3 ` 7-- It -7 C- 7
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall
Date
50050
No.
Sample
Collected
Total
Flow if a
Total .
Rainfall,
Sum
55
Resl
r�w3Q t i4sL:
molddlyr
MG
inches
rr, 9 (C.
I OnI IIr-1I- li't I I n.S I C6 I < 0 . 0 1 1 a.5z_ 1 6.L1 I I I
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Oyes ®no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity MonitoringRe uirements
`Outran Date sooso ': , 0055 11 - W 166530=
No 7 Sam le . gTotal Flow xTotal 50i 1Grease `lYo polar k Total. '`H: eK 1Vlotor•Y`
r" , Go1le�ted' =' {�fapplicakale}Rainfall g (�f•appl.) O&G/7 PH Suspended' Oil Usage
(Method 166'4 sSolitis
SGT'HEM); if s f
�x y �a 1:
Form SWU-247, last revised 611212015
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date 1Z (cS }Q
Total Event Precipitation (inches): 0 a 5
Event Duration (hours): (only if applicable - see permit,)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable - -see permit.)
Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Attn: Central Files
1617 ,Mail Service Center
Raleigh, North Carolina 27699-1617
"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 are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
(Signature of P#irfW (Date)
Form SWU-247, last revised 611212015
Page 2 of 2