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ROY COOPER g y r:
Grvrrner t [, /O
ELIZABETH S.BISER :\ _ � ` •;y
Srcr.:ory •i a6^�a,
DOUGLAS R.ANSEL NORTH CAROLINA
Mnrrrrm Dir.'rtar Environmental Quality
Stormwater Delegation of Signature Authority Form (DOSA)
This form shall be used to delegate signature authority from the permit Owner (Permittee) to
another party. Only the Responsible Official defined below may submit permit applications and
reports required by the permit(such as Data Monitoring Reports and Annual Reports) until this
form is completed and submitted to the DEMLR Stormwater Program. Please note that delegating
s nature authority does not relieve the Permit Owner from the responsibili andty compliance for
permit compliance.
Permit Owner:The legal entity to which/whom a permit has been issued and may be an individual
or an organization such as a company or government agency. Every Owner is required to have a
Responsible Official who meets the legal signature authority requirements in 40 CFR 122.22,
summarized below:
• Fora corporation,the Responsible Official shall bea president,secretary,treasurer,or vice president
in charge of a principal business function,or another individual who performs similar functions for
the corporation,or the manager of one or more manufacturing,production,or operating facilities
who is authorized to make management decisions about the facility operation.
• For a partnership or sole proprietorship,the Responsible Official shall be a general partner or the
proprietor,respectively;or
• For a municipality,State,Federal,or other public agency,the Responsible Official shall be either a
principal executive officer[City/County Manager]or ranking elected official[Mayor].
Please mail the DOSA Form with original wet signatures to: NCDEMLRStormwater
Program, 1612 MSC,Raleigh, NC 27699-1612
Name of Organizational Entity L L`12,
rmit.g.tf.4-ne!JP'l_y i i4C •
Responsible Official Name
Rini N1 HO( T6i.)
Responsible Official Title:
PLANT- D'iP\l\lg4%2
Email Address: Phone •
KEv IN)• o(ai (c•)kV0(Et A,(c,M ( 5 )2443-6(,35
Mailing Address
iC 0 1:k1b0:-SiP.IAl. PA(ZV- (fib 14E10.6050N1/IIlpC.207
City State Zip code
NE!�D2-t ' ViLL NC 267gi(
--�1 North Carolina Department of Environmental Quality 1 Division of Energy.Mineral and Land Resources
DE -;) 512 North Salisbury Strccl 11612 Mail Service Ccntcr 1 Raleigh.North Carolina 276 -1612
...v.........el r.»7..+.o.wr 019.i 07.9200

A. Persons to Receive Signature Authority
The signatures of the persons listed below indicates their acceptance of signatory authority.
Attach additional pages if you need more space.
Delegated Party Name 1J1�1Py1� I(Cf.UJA��
Delegated Party Title S4 ENS r N�tv'at,t5 i
Permit Number(s) f�iCC jC 7GGCL
Email Address: 011,17-►, , Y , Phone
l<.crJr„AP c� l`voC,E('a:Cvr� ZA 573 )G i y
Mailing Address LC., �!�;J.•��i1�iAi QA�k 12.b •
City
HENJ6 Lp.s6i.) t State AIL Zip code Z"•Z-1
Signature of Delegated Party
indicating acceptance of
Signatory Authority: ' �✓i<<%�
Date GJ - i L(-ZH
Delegated Party Name DCV (N-L_1DA2.5
Delegated Party Title a12 CI-1 .
5 GCNI 21.czqLIST-
Permit Number(s)
I\<1 G•7ooc0
Email Address: n �,
nG .-UCi tAS• I 'IC �A LS _ yOcEaccA Phone (�26;)4-15 8.5-6 S
Mailing Address ICC 11-Nibv61ia1L\L pAta �i
City State Zipcode
eNIJf.lSGh1Y1\-L l�� Z� r 1I
Signature of Delegated Party
indicating acceptance of
Signatory Authority: . � L ]`� •
Date 03 1L-1 -Z--I
Delegated Party Name
Delegated Party Title
Permit Number(s)
Email Address: Phone
Mailing Address
City State Zip code
Signature of Delegated Party
indicating acceptance of
Signatory Authority:
Date
Stormwater Permit Delegation of Signatory Authority Form
Page 2

B. Responsible Official Signature
The Responsible Official,as identified in accordance with 40 CFR 122.22, is the appropriate
individual with the authorityto sign and submit reports for the organization.
As the Responsible Official,I, KEVIN) I-I-LT1 c;kk (printed name),
have the authorityto enter into this Agreement for
. (Owner/Organization Name).
I request that the DEMLR Stormwater Program include the persons listed in Part A of this
form signatory authority for the above-named permit.
I acknowledge that I,and the persons listed in Part A of this form work at/for my
organization and have authorityto act as a signatory for purposes of the NCDEQ's
electronic document systems.
By submitting this application,I, Kc V i'v 4Dli (printed name),have read,
understand,and accept the terms and conditions of the stormwaterpermit(s)for which I
am the Responsible Official.
Responsible Official Signature
Title Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3

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Pace Analytical Services,LLC
Pace2225 Riverside Dr.
Asheville,NC 28804
[phone]
March 13, 2024
Mr. Doug McDaris
Kyocera Engineered Ceramics
100 Industrial Park Rd.
Mountain Home, NC 28758
RE: Project: Stormwater
Pace Project No.: 92717411
Dear Mr. McDaris:
Enclosed are the analytical results for sample(s)received by the laboratory on March 06,2024. The results relate only to
the samples included in this report. Results reported herein conform to the applicable TNI/NELAC Standards and the
laboratory's Quality Manual, where applicable, unless otherwise noted in the body of the report.
The test results provided in this final report were generated by each of the following laboratories within the Pace Network:
• Pace Analytical Services-Asheville
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
•
Jonathan W Biddix
[e-mail]
704-977-0978
Project Manager
Enclosures
Q ACCR f�.
REPORT OF LABORATORY ANALYSIS
TNI ' This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,LLC. Page 1 of 10
8QRA

Pace Analytical Services,LLC
( ! 'ace 2225 Riverside Dr.
Asheville,NC 28804
[phone]
CERTIFICATIONS
Project: Stormwater
Pace Project No.: 92717411
Pace Analytical Services Asheville
2225 Riverside Drive,Asheville,NC 28804 South Carolina Laboratory ID:99030
Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001
North Carolina Drinking Water Certification#:37712 VirginiaNELAP Certification#:460222
North Carolina Wastewater Certification#:40
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 10

Pace Analytical Services,LLC
2225 Riverside Dr.
gace• Asheville,NC 28804
[phone]
SAMPLE ANALYTE COUNT
Project: Stormwater
Pace Project No.: 92717411
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92717411001 OUTFALL 1 SM 2540D-2015 JMH1 1 PASI-A
92717411002 OUTFALL 2 SM 2540D-2015 JMH1 1 PASI-A
PASI-A=Pace Analytical Services-Asheville
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 10

Pace Analytical Services,LLC
ace 2225 Riverside Dr.
Asheville,NC 28804
[phone]
ANALYTICAL RESULTS
Project: Stormwater
Pace Project No.: 92717411
Sample: OUTFALL 1 Lab ID: 92717411001 Collected: 03/06/24 08:05 Received: 03/06/24 16:00 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Asheville
Total Suspended Solids 18.9 mg/L 2.5 1 03/12/24 12:49
Sample: OUTFALL 2 Lab ID: 92717411002 Collected: 03/06/24 08:11 Received: 03/06/24 16:00 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2015
Pace Analytical Services-Asheville
Total Suspended Solids 16.9 mg/L 2.5 1 03/12/24 12:49
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/13/2024 02:10 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 10

Pace Analytical Services,LLC
2225 Riverside Dr.
aV//'_�a Asheville,NC 28804
[phone]
QUALITY CONTROL DATA
Project: Stormwater
Pace Project No.: 92717411
QC Batch: 838323 Analysis Method: SM 2540D-2015
QC Batch Method: SM 2540D-2015 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92717411001,92717411002
METHOD BLANK: 4330269 Matrix: Water
Associated Lab Samples: 92717411001,92717411002
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 03/12/24 12:46
LABORATORY CONTROL SAMPLE: 4330270
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 254 102 90-110
SAMPLE DUPLICATE: 4330722
92717333001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 1480 1220 19
SAMPLE DUPLICATE: 4330723
92717355001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 2680 2580 4
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:03/13/2024 02:10 PM without the written consent of Pace Analytical Services,LLC. Page 5 of 10

Pace Analytical Services,LLC
Pace 2225 Riverside Dr.
Asheville,NC 28804
[phone]
QUALIFIERS
Project: Stormwater
Pace Project No.: 92717411
DEFINITIONS
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.
MDL-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(D)-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.
Reported results are not rounded until the final step prior to reporting.Therefore,calculated parameters that are typically reported as
"Total"may vary slightly from the sum of the reported component parameters.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI-The NELAC Institute.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/13/2024 02:10 PM without the written consent of Pace Analytical Services,LLC. Page 6 of 10

Pace Analytical Services,LLC
2225 Riverside Dr.
ace Asheville,NC 28804
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Stormwater
Pace Project No.: 92717411
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92717411001 OUTFALL 1 SM 2540D-2015 838323
9271 7411 0 02 OUTFALL 2 SM 2540D-2015 838323
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:03/13/2024 02:10 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 10

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Page 8 of 10

DC# Title: ENV-FRM-HUN1-0083 v03_Sample Condition Upon Receipt
ace
Effective Date:12/01/2023
Laboratory rec wing samples:
Asheville [ Edenn Greenwood n Huntersville❑ Raleigh❑ Mechanicsville❑ Atlanta❑ Kernersvillen
Sample Condition Client Name: WO# ' 92717411
y
Upon Receipt J.4 r i Project H. i
l PM: JWB Due Date: 03/21/24
Courier: ❑Fed Ex ❑UPS ❑USPS ❑Client CLIENT: 93-Kyocera
❑ Commercial []Pace ❑Other:
Custody Seal Present? likes g1 o Seals Intact? Oyes No ❑N/A
Date/Initials Person Examining Contents: YE'.11
Packing Material: ❑Bubble Wrap ❑Bubble Bags :None Er-Other Biological Tissue Frozen?
Thermometer: ❑Yes ❑No ON%A
❑ IR Gun ID: r7-3*ti JL Type of Ice: 1 ❑Blue UNone
Correction Factor:
Cooler Temp: - Add/Subtract('C) ) __ Temp should he above freezing to 6'C
['Samples out of temp criteria.Samples on ice,coaling process
C.i Cooler Temp Corrected(°C): ' . '? has begun
USDA Regulated Soil( N/A,water sample)
Did samples originate in a quarantine zone within the United States:CA,NY,or SC Did samples originate from a foreign source(internationally,
(check m aps)?Dyes ❑No including Hawaii and Puerto Rico)?['Yes ONO
_ Comments/Discrepancy:
Chain of Custody Present? arcs ONo ON/A _ 1. _
Samples Arrived within Hold Time? Efes ❑No ON/A 2.
Short Hold Time Analysis(<72 hr.)? ❑yes .(2ffo ON/A 3.
Rush Turn Around Time Requested? ❑Yes Otto ❑N/A rl.
Sufficient Volume? }]Yes ONo ON/A S.
Correct Containers Used? 'Dies ONo ON/A 6
Pace Containers Used? ,-t,Yes ONo ON/A
Containers Intact? ,E s ONo ON/A _ 7.
Dissolved analysis:Samples Field Filtered? OYes ONo N/A 8.
Sample labels Match COC? fires ONo ON/A 9
-Includes Date/Time/ID/Analysis Matrix:
Heaclspace in VOA Vials(>5-6mm}? Des ONo v/A 10.
Trip Blank Present? Oyes ❑Nu j:IN/A" 11.
Trip Blank Custody Seals Present? Oyes ❑No ❑N1st"
COMMENTS/SAMPLE DISCREPANCY Field Data Required? Oyes ONo
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted: Date/Time:
Project Manager SCURF Review: Date: _
Project Manager SRF Review: - Date:
Page 9 of 10

DC#_Title: ENV-FRM-HUN1-0083 v03_Sample Condition Upon Receipt
/Pgce
Effective Date: 12/01/2023
*Check mark top half of box if pH and/or dechlorination is verified and Project N WO# : 92717411
within the acceptance range for preservation samples. PM: JWB Due Date: 03/21/24
Exceptions:VOA,Coliforrn,TOC,Oil and Grease,ORO/8015(water)DOC,LLI Ig CLIENT: 93—Kyocera
**Bottom half of box is to list number of bottles
***Check all unpreserved Nitrates for chlorine
•
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U
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y
40. :5m O p =O N c� a a NO iJ .. p cl a i '-' iv o > v
iccn
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pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Dale preservation adjusted Time preservation Amount of Preservative Lot 1I
adjusted added
Note: Whenever there is a discrepancy affertinp North Carolina compliance samples,a ropy of this form will be sent to the North Carolina DEAR Certification Office(lc.
Out of hold,incorrect preservative,nut of temp,incorrect containers. Page 10 of 10