NCG030306_MONITORING INFO_20180619 (2)

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
N CCU O 3 O
DOC TYPE
��TORICALFILE
❑ ONITORING REPORTS
DOC DATE
❑ 1,26 I o 0
YYYYMMDD

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Mr. Virgil Yancey
Jacobsen A Textron Company
11524 Wilmar Blvd.
Charlotte, NC 28241
Dear Mr. Yancey:
CENt RAL FILES
DWR SECTION
June 19, 2018
ROY COOPER
Govemor
MICHAEL S. REGAN
Secretary
WILLIAM E. TOBY VINSON, JR.
Interim Director
Rescission of NPDES Stormwater Permit
Permit Number: NCG030306
Mecklenburg County
On April 23, 2018, the Division of Energy, Mineral and Land Resources received your request to rescind your
NPDES Stormwater Permit Number NCG030306. In accordance with your request, Stonnwater Permit
Number NCG030306 is rescinded effective immediately.
Operating a treatment facility, discharging wastewater or discharging specific types of stormwater to waters of
the State without valid coverage under an NPDES permit is against federal and state laws and could result in
fines. If something changes and your facility would again require stormwater or wastewater discharge permit
coverage, you should notify this office immediately. We will be happy to assist you in assuring the proper
permit coverage.
If the facility is in the process of being sold, your will be performing a public service if you would inform the
new or prospective owners of their potential need for NPDES permit coverage.
State of North Carolina I Environmental Quality I Energy, Mineral, and Land Resources
Central Office j 1612 Mail Service Center I Raleigh, NC 27609
919 707 9200

If you have questions about this matter, please contact the Mooresville Regional Office at [phone],
Sincerely,
4a/ �
for William E. Toby Vinson, Jr., PE, CPESC, CPM
Interim Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office
tormwater Permitting Program
Central Files

L'P
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
Environmental
Quality RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
mmm
Day
Please fill out and return this form if you no longer need to maintain your NPDES stormw/a�terperrmit.
1) Enter the permit number to which this request applies: PC 6—o 30 3o
Individual Permit (or) Certificate of Coverage
N 1 C I SIT] N I C I G O 3 a 10 0 0
2) Owner/Facillty Information: ' Anal correspondence will be malled to the address noted below
Owner/Facility
Facility Contact
Street Address
city
County
Telephone No.
Jacobsen A Textron Company
Virgil Yancey
1451 Marvin Griffin RD
Augusta
Richmond
[phone]
State GA
E-mail Address
Fax: ()7061
ZIP Code 30906
[e-mail]
955-4554
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
0 Facility closed or is closing on 2/16/18 . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to
on . If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
❑ Other:
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete and accurate.
y ..
R ki �
Signature`A oxt � Date 2/$/18
Virgil Yancey EH5 Manager
Print or type name of person signing above Title
Please return this completed rescission request form to:
Revised 20181an10
DEMIR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
�fld
i s .5 2018 YW f�
D r s �,�

1
A Texcra+ CC -Parry
VIA CERTIFIED MAIL
June 6"' 2017
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of May 2017. Stormwater samples from a measurable storm event
were not collected this monthly period due to precipitation events occurring after business hours during on
weekends.
Sincerely,
Jacobsen, A Textron Company
Chris Wissinger
Facility/Environmental Manager
Attachments

RECEIVED
CENTR ,L FILES
DW ; SECTION
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO30WO
Date submitted to- 5 - i 7
CERTIFICATE OF COVERAGE NO. NCGO30306 SAMPLE COLLECTION YEAR 2017
FACILITY NAME Jacobsen, A Textron Company SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
COUNTY Mecklenburg or ® Monthly' - - - --Lmonth)
PERSON COLLECTING SAMPLES: NA DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY: Shealy Environmental Inc. Lab Cert. 9 NA ❑Zero -flow [-]Water Supply ❑SA
Comments on sample collection or analysis: ®der— C -
None
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
Part A: 5tarmwater Benchmarks and Monitoring Results
M No discharge this period?'
Outfali No.
Date Sample
Conected'
(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
Organtcs'
Benchma+irs =>
_
too mg/L or so mg/0
6.0 - 9.0
0.007 mg/L
0.03 mg/L
0.067 nWL
15 mg/L
1 mdi.
swool
NA
NA
NA
NA
NA
NA
NA
NA
NA
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'For sampling periods with no discharge at any single outfall, 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.
' See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 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 433A1; 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
starmwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the ail the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
CHRIS WISSINGER _
Name (Print name)
FACILITIES MANAGER
Title (Print title)
7
(Signs re) {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_,'QO( mg/L', where XX is the numerical value of the detection
limit, reporting limit, etc, in mg/L.
Nate. If you report a sample value in excess of the benchmark you must Implement Tier 1, Tier Z or Tier 3 responses_ See General Permit text.
Part B: Vehide Maintenance Area Monitoring Results: only for facilities averaging > SS gal of new all per month.
n No discharge this Deriod?z
Outfall Na,
Dow Sample
C,flected'
Imo/dd/yrl
244mur rainfall!
amount
Inches,
Non -polar OSG/TPH by
EPA 1664156T-HEM}
Total Suspended Solids
pH
Benchmarks
is mg/L
100 mg/L or So mg/L•
&0 — 9.0 SU
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017 SWu-245, last revised 10/25/2012
Page 2 of 3

r
Note: If you report a sample value In excess of the benchmark you must Implement Tler 1, TJer Z or 77er 3 responses. See Genemil Permit text.
FOR PART A AND PART B MDNITORING 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 FAGUTY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ®NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT NAME: Marcia Allocco — Mooresville Rgglonal Office & Ken Pickle — Central Office
MoJI an or final and one caov of this DMR Jndudirw all "No DJs�a►tre' reports, strithin 30 days of recefvt of the lab r>`srrlts for at errd of manitarina period
Jn the ease of "No _Dhdwn e_'repMftj 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 are significant penalties for submitting false information, Induding the p=lbility of fines and Imprisonment for knowing violations."
. `.. - t - r
{Signatur Permitteej (Date)
Permit Date: 1111/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

RECEIVED
MAY 10 2011
CENTRAL FILES
DWR SECTION
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO30M
Date submEtted
CERTIFICATE OF COVERAGE NO. NCGO30306 SAMPLE COLLECTION YEAR 2017
FACILITY NAME Jacobsen A Textron Company SAMPLE PERIOD ❑ Jan -June ❑ July-0ec
COUNTY Mecklenburg or ® Monthiyl t onth)
PERSON COLLECTING SAMPLES: NA DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY: Shealy Environmental Inc Lab Cert. # NA ❑Zero -flow ❑Water Supply ❑SA
Comments on sample collection or analysis: ®Other C
None
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
No discharge this oeriod?2
outfall No.
Date Sample
Collected°
(ma/dd/pr)
244hour rainfall
fi
amaulrt,
Inches'
Total Suspended solids
pH,
Standard units
Copper
Lead
Zinc
G&G/
Total Petroleum
Ffydrocar6°e+s
Totaf Toxic
OrEar+kss
Benchmarks _=a
_
100 mg/L or 50 mg/L'
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
is mg/L
1 mg/L
SW601
NA
NA
NA
NA
NA
NA
NA
NA
NA
' Monthly sampling (instead of semiannual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
' For sampling periods with no discharge at any single outfall, 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.
' 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 bate: t1/i/2012-10/31/2017 5WU-245, last revised 10/25/2012
+ Page 1 of 3

Note: if you report a sample value in excess of the bendrmadi you must Implement Tler 1, Tler Z or Tier 3 responses` See Genera! Permit text
FOR PART A AND TART 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 EXCEEOENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ®NO ❑
IF YES, HAVE YOU CONTACTED THE DWO REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT NAME: Mar ' Allocco — MooresWle Regional Office & Ken Pickle — Central Offs
Mall an a►lainal and one corny of this DAM, Indudlna all '1Yo Dlschorae' neoortx wlthln 30 days of recelo! of the lab resalts for at end of monfto na aertod
In the case of"No Disdwroe_" re-ports�:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN TtfIS 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 a ccordance 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.
am aware that there are significant ppnalties for submitting false Informaoio'n, induding the possibility of fines and Imprisonment for knowing violations.'
(Signature of Permittee) (Date}
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 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 managemenit plan included in the Stormwater Pollution Prevention Plan."
CHRILS WFSSiING$R
Name (Print name)
FAGLITIFS MANAGER
Title (Print till
7
(Signatu a (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 he LeMed in the fiLrmat. "Ol midL" where Xl( 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 baw nxirk you must implement Tier 1, Tier 2, or Teri responses. see General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
Fi No discharge this oeriod?r
Outfall No.
Bate Sample
Collected'
(mo/dd/yr)
24-hour rairhfa0
amount,
Inches'
Non -polar O&Gf rPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks —>
_
-
15 mg/l
200 mg/L or 50 mg/L'
&0 — 4.0 SU
NA
NA
NA
NA
NA
NA
Footnotes from Part A also apply to this Part B
' See General Permit text, Table S. identifying the especially sensitive receiving water classifications where the more protective benchmark applies_
Permit Date: 11/1/2012-10131/2017 SWU-245, last revised 10/25/2012
Page 2of3

F100�
40
a reYtron company
VIA CERTIFIED MAIL
May 7" 2017
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of January 2017. Stormwater samples from a measurable storm event
were not collected this monthly period due to precipitation events occurring after business hours during on
weekends.
Sincerely,
Jacobsen, A Textron Company
Chris LWissinger
Facility/Environmental Manager
Attachments

RECEIVED
MAR 13 2017
CENTRAL FILES
DWR SECTION
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 3 - `Z - (7
CERTIFICATE OF COVERAGE NO. NCGO30306 SAMPLE COLLECTION YEAR 2017
FACILITY NAME Jacobsen, A Textron Company SAMPLE PERIOD ❑ Jon -June ❑ July -Dec
COUNTY Mecklenburg or ® MonthW February !month!
PERSON COLLECTING SAMPLES: Tyler Rushin DISCHARGING TO CLASS []ORW DHQW ElTrout QPNA
LABORATORY: Shealy Environmental Inc_ Lab Cert. 0 329 QZen -flow Elwater Supply []SA
Comments on sample collection or analysis: ®Mer C
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
n No dischvrde this period?'
No.
Date
Date Sample
Collected'Outfall
(ma/dd/
244wur rainfallpH,
amount,
Inctice
Total
Stanunits
Copper
Lead
2mc
Non -Polar O&G/
7lo�I P
itadard
Total Toxic
Organicss
Bendrrrr U*3 =a
_
100 mg/L or 50 mg/L4
6A — 9.0
0A07 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
SWODI
OVIS/17
0.7S
13 Fng/L
7A6 su
Wnl) L
0.0013 nwA
0AW mg/L
<5.1 nwI
—
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedanee for the same parameter at the same outfall,
' For sampling periods with no discharge at any single outfall, 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 5WU-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 Starmwater Pollution Prevention Plan."
CHRIS WISSINGER
Name (Print name)
FACILITIES NV1NAGER
Title Prifi title)
{Signature) (Bate)
Note: Results must be reported in numerical format. Do not reeort, Below Detection limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be retorted In the format, `<XX mx/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 0 the bermdunarly you must implement 71er I, Tier Z, or 77er 3 responses. See General P+em* text
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > SS gal of new oil per month.
n No dischame this neriod?z
Dutfall No
[rate Sample
C'U"ted'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
. Total Stapended Solids
pH
8enchrrrarfcs
_
-
is mg/L
10o mdL or 50 mg/L•
6.0 — 9.0 SU
NA
NA
NA
NA
NA
NA
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: 31/1/2012-10/31/2M7 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: tf you report a sample value in excess of the benchnrarfy you must implement Tier 3, Tier Z 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 11 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: Marcia Allocco — Mooresville Regional Office & Ken Pickle —Central Office
Mail an original and one copy of this DMR. Including all 'No Dfsd gMe" reports. within 30 4W pf ma int 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 property 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and Imprisonment for knowing violations."
C'&: I � ) -, /I 3-a-
(Signature of Permittee) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

APPENDIX z
Farms and Data to Be Included in Annex F of the Jacobsen Facility One Plan

TIER ONE/TWO/THREE STORMWATER RESPONSE
DOCUMENTATION RECORD
Directions: Complete this form in entirety if an analytical benchmark is exceeded.
Records: The general stormwater permit requires that this form be maintained in the
facility's SWP3.
I. Compliance Dates
a. Samples collected
b. Sample results received
c. Tier stormwater management inspection due
(must be within 2 weeks of date above)
d. Tier stormwater management inspection
conducted
e. Implementation of selected actions deadline
(must be within 2 months of date "d" above)
11. Data
Date
02/15/17
03/03/17
03/17/I7
3 - 9g�7
Current
Previous 1*
Previous 2*
Outfail No.
Parameter
Benchmark
Analytical
Results
Results
Value/Units
Result
Date:09/26/16
Date:05/19/16
Value/Units
TSS
100 m
13 m
140 m
13 mgfl
SW441
Total Copper
0.007 m
0.010 m
0.020 mA
0.0054 m 1:11
Total Zinc
0.067 m
0.100 m
0.110 m 01
0.033 mall
* If Previous 1 result was also exceeded, theft implement Tier Two monthly monitoring. Continue until current, Previous I and
Previous 2 results are all under the benchmark. If during permit term, analytical results indicate benchmark exceedance for any
specific parameter at any specific outfail four (4) times, the outfali is considered to be in Tier 3 and written notice should be sent to
the DWQ Regional Supervisor within 30 days of the fourth sampling result.
D1. Inspection Results
Conduct an inspection of the drainage area to the outfali and record the date in "d" above. Person(s) conducting inspection
A r P��c i ua N m d�-(� r j� 0 r -t} 1'<1. V g 1 C &-,i S- TO f
a. Identification of possible causes of exceedance
b. Identification of possible controls/improvements (identify at least one)
U/Source Control
0 Operational Controls ^
0 Physical Improvements
❑ Other
W. Implementation Record
Describe the actions completed to address the exceedance. If exceedance reoccurs in the next sampling, Tier Two actions are
mandated. ,
91 d 9gt k d- to 3-.3-l7
r
V. Maintain this form in the SWP3 per general Stormwater permit requirements.

��w
,v!'
;KA
Stornuwater DiSehaMe Outfal
Qualitative Monitoring 1 CSDa�
Report
Forguidance Dlr fll/Mg out thirfann please wfsft
Permit No.: JJr, 1_1 /n / 0
a nc nr.0r2We W w
FaC111[J7 Name: acob e �—� or Certificate of Coverage ivo..
Te
County: b
Phone No. - 9 4
Inspector: C S ' -
Date of Inspection:
Time of inspection: 5
Sri f
Total Event Precipitation (inches)-.--,-...
Was this a 'Representative Storm Event"" or ^Measureable Storm Event' as defined by the perrnit7
(see .)
information below
UeiYes ❑ No
Please verify whether. Qualitative Monitoring must be performed during a 'representative storm
event" or ineasureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a 'representative storm event" or during a "measureable storm event- However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event' is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation_
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 DWQ Regional Office.
By this signature, I certify thaw -report is accurate and complete to the best of my knowledge:
{Signature of
Page 1 of 2
srvu-242, Last medifled 10/25/2012

I. Outfall De
Outfall No. � "Pdon:
Receiving Stream: ~ Sire (pi e
Describe tram tri u P .ditch, etc.)
the industrial a t° S e �Occur
Cl7vltwithin the outel]a Ce a uiment-m—,.r�_,tfalI dnage area:
2. Color. Describe the color of the discharge using basic colors red, bro (light; medium, dark) as descriptors: wn, blue, etc.) and tint
3. Odor: Describe any distinct od rs that the discharge may have (Le., smells strongly of oiL
weak chlorine odor, etc.);
4. Claritq' Choose the number which best describes the clarity of the discharge, where i is
clear and 5 is very cloudy:
3 2) 3 4
5
5. Floating Solids: Choose the number which hest describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is t1le surface covered with floating solids-
0 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:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
ffff _ ,
List and describe — _ �',�¢g P� 1� Y ��]/ �r' fJ 1'ri i j` l'� p
C V h tl L7�1 1
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 10/25/2012

STORM EVENT DATA RECORD
Name of Facility: Jacobsen
Location: Outfall SW001
No. of Ouifalls or Sample Locations =
Instructions: Fill in ALL blank boxes and lines
Tune interval
:. A,ctztal Time
Rain Gauge:. -
(minutesf)
(Hr• Mon.)
Reoard',(tnch)
0
0
Storm Begins
q
a3
samples Collected
,q
8? 5] 1 M
.,
o
storm_
a
Date
No. of hours since previous measurable rain (0.1 inches) 1 f hrs.
pH of samples: Record pH of the outfalk
e
Raia,Ga
�
7 +
Samples collected by f ,) jP r lZ 0-ki n
Rain gauge reading taken b ,
pH meter read by: a> �4i
Is Outfali Visual Monitoring Record atteclfed for the out&U?_y c
NOTES:
(1) Tune zwo (0) means the binning of storm or as soon as discharge from sample point
becomes visible.
(2) The rain gmw level and time mpg be recorded at the end of the stern event.

PAGE NO.
DAILY RAINFALL RECORD, 7 d
IJ+ 1 iuuv bi it A Can �r.rEa bAll .. IT
I
©
MMA
"
r
%
i
Iro
G'
i
_
f
s
!
NOTE: Read gauge ai roughly the same time each day- Ernpty gauge afier reading, unless stotmv-,Wer samples are
being collected Itl this event, wait till storm is over and COITCCI enure raun g e reading for representative stpnn

SHEALY ENVIRONMENTAL SERVICES, INC.
Report of Analysis
Jacobsen, Inc.
11524 Wilmar Blvd
Charlotte, NC 28241
Attention: Chris Wissinger
Project Name: Jacobsen Storrnwater
Project Number:300-25
Lot Number:SB15053
Date Completed:0212412017
Kelly M. Nance
Project Manager
Arm LABORATORY
ACCREDITATION
BUREAU —.6
ACCREWMawwrmn
This report shall not be reproduced, except in its entirety, without the written approval of Shealy Environmental Services, Inc.
The following non -paginated documents are considered part of this report: Chain of Custody Record and Sample Receipt Cheeldist.
Shealy Environmental Servioes, Inc. Page: 7 of 5
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealyiab.com

SHEALY ENVIRONMENTAL SERVICES, INC.
SC DHEC No: 32010 NEtAC No: E87653 NC DENR No: 329 NC Field Parameters No: 5639
Case Narrative
Jacobsen, Inc.
Lot Number: SB15053
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary following this Case Narrative. The sample
receiving date is documented in the header information associated with each sample.
All results listed in this report relate only to the samples that are contained within this report.
Sample receipt, sample analysis, and data review have been performed in accordance with the most current approved NELAC standards, the
Shealy Environmental Services, Inc. ("Shealy") Quality Assurance Management Plan (QAMP), standard operating procedures (SOPS), and Shealy
policies. Any exceptions to the NELAC standards, the QAMP, SOPS or policies are qualified on the results page or discussed below.
If you have any questions regarding this report please contact the Shealy Project Manager listed on the cover page
Shealy Environmental Services, Inc, Page: 2 of 5
106 Vantage Point Drive West Columbia, SC 29172 (803) 791-970o Fax [phone] Www.shealylab.com

SHEALY ENVIRONMENTAL SERVICES, INC.
Sample Summary
Jacobsen, Inc.
Lot Number: SB15053
Sample Number Sample ID Matrix Date Sampled Data Received
001 SW001 Aqueous 02/15/2017 0800 02/15/2017
Shealy Environmental Servioes, Inc. Page: 3 of 5
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.sheatylab.com

Inorganic non-metals
Client:Jacobsen, Inc. Laboratory 10:SB15053-001
Description: StW001 Matrix: Aqueous
Date Sampled:02 I512017 0800
Date Received:0211512017
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Data batch
1 (TSS) SM 254OD-2011 1 02121/2017 0841 AMM1 35140
1 (SGT - HEM (n) 1664B 1 02/22/2017 1203 JMM 35273
CAS Analytical
Parameter Number Method Result Q PQL Units Run
TSS SM 254OD-20 13 1.3 mg1L 1
SGT - HEM (non -polar material) 16W ND 5.1 mg/L 1
PQL = Practical quantitation lima B = Delecled in the method blank E = Quanbta4on of compound exceeded the colibrauDn range H = Oul of Folding time
ND = Not detected at or above the PQL J = Estimated result < PQL and � MDL P = The RPD between two GG ootumns exceeds 40% N = Recovery is out of criteria
Where applicable, all soil sample analysis are reported on a dry weight basis unless flagged with a'W
Shealy Environmental Services, Inc. Page: 4 of 5
108 Vantape Point Drive West Columbia, SC 29172 [phone] Fax [phone] vmrw.sheaTytab.cmrn

!CP-MS
Client: Jacobson, Inc. Laboratory ID: SB15053-001
Description: SW001 Matrix: Aqueous
Date Sampled:0211512017 0800
Date Received: 02/1512017
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 200.2 200.8 1 02/16/2017 2029 BNW 02/16/2017 0829 34738
CAS
Analytical
Parameter
_ Number
Method
Result a
PQL
Units Run
Capper _
7440-50-8
200.8
10
1.0
u9A. 1
Lead
7439-92-1
200.8
1.3
1.0
uglL 1
Zinc
744046-6
200.8
100
10
uglL 1
PQL = Practical quantitation Tune B = Detected in the method Wank E = Quantitation of compound exceeded the calibration range H = Out of holding time
ND = Not deWad at or above the PQL J = Estimated result < PQL and > MDL P = The RPD between two GC columns exceeds 40% N = Recovery is out of aiteria
Where applicable, all Boil sample analysis are reported on a dry weight basis unless flagged with a -W'
Shealy Environmental Services, Inc Page: 5 of 5
106 Vantage Point 06ye West Columbia, SC 29172 [phone] Fax [phone] www.sheatylab.com

Chain of Custody
and
Miscellaneous Documents
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com

1�
lr

Shealy Environmental Services, Inc.
�� 108 Vantage Poln1 Dd+rs
Chain of Custody Record West Columbia, South Carolina 29172 Number
Telephone No. (603) 791.97DO Fax No. [phone]
www.sAeatylab.com
clam
joeobs"
Roport to conuld
$vnenth Danmm
Srarnplw (PrIlrded Nam)
C. 6LO{�
Quota No.
Address
11524vWImarGIA
ToWphano No. (Fax Ko.1 Emall
sarnw&dowsonallaaanvimaran, com
iLyblR No.
Pape
I of
Ih
Charlotte
State
NC
Zip Code
2a273
Preservatjve
1. tJM"- 4. H403 7. NaOM
2• NaOHfZnA 5 HCt.
I R2804 e. No Theo.
1
t
11
1
1
1
Number of Corrlainers
K
J
O
Boitle
Projed fume
Jaaabamr SW
1
5
4
+�4aervallve
!1 ��1 C�r
1;19199
615053
M
+�
►^
y
30"S Nunmar
P, hiunafer
McMx
sample IU 1 Daseriplion
(CantaYnera for aadr aamplo may tie
oornblrml on qna lire}
Cate
Time
t?Vr
aW
WW
5
SW001
+ i i
�,+
a
X
X
X
X
Metals to be analyzed by
ICP-M8
Tray.Arcum UnoR4*AValPnarlm&OPM MgUhadhxaKDWft4rATj
rmd ❑RuMj'F%anGPIW
9anOs0iapaaal
AM= to Coni niyosel by Lab
QC RagftmeMs(Please Sgaeify7
Feasible 414mMirnton
abl�8tn lrri
an UnkncMnB
1. Ro in0shW by / 8anpler
�7
De
j1 il-7
Timor
+. Ro ad by
Date
• I,-7
Time
13. 2. ReTsAea
par
Time
2, rtla0hrod by
tole
imna
Ratinqui ed by
pale
Time
5. Received by
Data
Time
4. f@alinggllhed by
Onto
Tang
4. Lebaralarr Rre d b
Date
z I
I `]'Z1
Note: Ail sampteo are retained for six weeks tfom recelpt unless other L49 USE ONLY
made Reatved an Ire {Chocel Y DN I= Pads
Rer TWW
u C
Temp. Blank
Y N
Eflecttve Data 06-27-2012
A
M
A
m
;a
C
n
hZh
1I

SHEALY ENVIRONMENTAL SERVICES INC.
sw=ly E.wmewzu seviem mr.
Decus�ren AumbQ htEJiplB�-0:
Peg..- I of I
E(GC,Ji a D44e: i WW2n16
EXP6g Dior. t 1.29CON
Sample Recelpt Checklist (SRC)
Client: Cooler Inspected bvidate: err .' z+ tS` 1-7 L+n C O
Mews of receipt:
SESI ra Client n L'PS D FedEx n other
Yes C
No
1. Were custod seals ptesent on the cooker
Yes C
No ❑ NAjff 2. If custod, seals were present, were they intact and unbroken?
pH strip IU: ( - _ Cl strip ID: _
Cooler 10Original [cmperan,Ite upon recciplr'DeIived (correcud) temperature upon receipt:
Method: o Temperature Slanlryt3 Against Bottles IR Gun ICf: tr Ile Gun Cormctian Faclor:F5 IC
Method of caolarrt: Wet lee a Blue Ice to Dry Ice o None
Yes ❑
No a
N"1,6
3. If tempera[ure of any cooler exceeded UrcC. was Project Margger Notified?
PM Was Mdfled =_ phone f email., Page -to -face (circle one).
Yes G
Na a
t!LkX
4. Is the commercial cnurier's g slip attached to this form?
Yes,X
No O
5. Wem procustody proc;�ures (relinquished1received) (blkrAvd7
Yes
No a
6. Were sample IDs listed an the Gt3C?
Yes
No G
7- Were sample ills listed on all sample containers?
Yes
No ❑
8. Was ccrll4 cdon date & time listed out the WC?
Na a
9. Was col lection date & time listed on all sam le containers?
WC
1 C. Did all container label information (ID. date, time) with the COC?
R
Vo a
11. Were tests to Iv rfornied listed on theCOC'
No a
12. Did all surnples atrive in the proper containers for each test ande'or in goW condition
(unbtu lids on, etc.)?
Yes
No [1
13. Was adecluate sam 1e volume avxilaWe?
No a
14. Were all samples received within'1, the holding time or 48 houm whichever comes first?
Na
15. Were arty samples containers missinly'ehc�ess (circle one) samples Not listed on COC?
5yes
No o
NA �
16. Were bubbles t >`pca-stxt" (V4'br 6mtn in diameter) in any VOA %vials?
No o
NA n
17. Were all DRO.finelaWnwricni samples rcccbmd at a pH of < 2?
No rt
NA zi
18. Were all c anide andlor sulfide samples received at a pH >12?
Yes D
No a
NA n
19- Were all applicable NH3.?KAEcyartide1phtnnVlJNA (<0.5rng/Q samples free of residual
chlorine?
Yes n
No o
NA a
20. Were collection teen ralta-m documented on she COC for NC samples?
Yes G
No o
NA
21. Were client remarkshequests (i.e. mquested dilutions, MS TvISD designations, etc...)
cure transcribed from the COC into the comment section in LINTS?
Yes ❑
No v
22. Was the quote number used taken from [hr. txwtuirter label?
Sampk Presenation (Must be cam load for any sam lc(s) i,ncen ectl reed or wish headspace_)
Sample(s)
sam 1e receivinK
were received incorrectly prescrvcd and %ere adjusted accordingly in
with tll�tiil,, FiVS3;, HCI. NaOH usin Si (i
sample(s) -T
_
were received with bubbles >6 mot in diameter.
Samples(s)
adjusted accordingly
_ were received with TRC >0.5 nig+L (if 921 is No) anti wrrn
in sample recei HnF, with sodium thiusulfate Nu7S;0, with Shea • 1D:
5C.' Drinking Waver project Sample(s) pH verified to be < 2 by Dam _
Sara I s were Not received at a H of < 2 mid were adjusted accorditt�ly using SR*
Sample labeis applied by: Verified by: Date:
tnents=
Shealy Environmental Services, Inc.
106 Vantage Point Drive Weat Columbia, SC 29172 [phone] Fax [phone] www.sheatylab.com

0
ATextmC.ompany
When Performance Matters."
VIA CERTIFIED MAIL
March 09, 2017
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
11524 Wilmar Blvd.
P.O. Box 7708
Charlotte, NC 28241
phone: [phone]
'J.ww.ja[obser—co:T
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form from the monthly stormwater sampling event conducted at our facility on February
15, 2017.
Sincerely,
Jacobsen, A Textron Company
Chris Wissinger
Facility/Environmental Manager
Attachments

Table 1
Stormwater Sample Compliance History
Jacobsen - Permit No: NCG030000 - (November 1, 2012 to October 31, 2017)
Year I Period Sample Date I Sample No.
Year 1
January 1, 2013 - June 30, 2013
Aril 4, 2013
1
July 1, 2013 -December 31, 2013
November 1, 2013
2
Year 2
January 1, 2014 - June 30, 2014
1 Aril 7, 2014
3
July 1, 2014 - December 31, 2014
1 November 17, 2014
4
January 12, 2015 5
Year 3 January 1, 2015 - December 31, 2015 March 27, 2015 6
October 28, 2015 7
Year 4
January 1, 2016 - June 30, 2016
February 23, 2016
8
February 23, 2016 - June 30, 2016
May 19, 2016
9
May 19, 2016 - December 31, 2016
September 26, 2016
10
Year 5
January 1, 2017 - June 30, 2017
February 15, 2017
11
July 1, 2017 - October 31, 2017
12
Notes:
1) Permit expires on October 31, 2017
2) Consecutive stormwater sampling events to be separated by 60 days unless in Tier 2 status,
or by permission from NCDENR.

Table 2
Historical Summary of Analytical Results
Jacobsen - Stomrwater Outfall SW001
Permit No: NCG030000 - (November 1, 2012 to October 31, 2017)
Outfall a MOW:
Sample Date
Parameter
Outtall
Stlaus�`
TSS (rrrgfl)
Non -Polar O8G
( )
Total lead (rr►g!1)
Total Copper
(m8►l)
Total Zinc
1MO)
Total Rainfall
(in.)
PH (s.u.)
04/04/13
28
<5.9
<0.010
0.0065
0.075
1.0
6.76
Tier One
11/01/13
6.2
<4.7
<0.010
0.0067
0.065
1.0
9.1
Tier One
04/07/14
8.7
<5.0
0.0013
0.0089
0.060
225
7.8
Tier One
11/17/14
160
<4.8
0.0056
0.040
0.270
2.25
7.83
TrerTwo
01/12/15
12
<4.8
<0.001
0.0045
0.031
1.00
8.9
Tier Two
03/27/15
12
<6.3
0.0012
0.0081
0.068
0.75
6.4
Tier TWO
10/28/15
5.5
<5.3
0.002
0-0098
0.044
2-50
6.01
Tier Three
02/23/16
11
<5.6
' <0.001
0.0038
0.082
1.75
6.50
Tier Three
05/19/16
13
<5.8
0.0011
0.0054
0.033
1.75
6.51
Tier Thee
09/26/16
140
<6.7
0.003
0.020
0.110
1.50
7.36
Tier Thee
02/15/17
13
<5.1
0.0013
0,010
0.100
0.75
7.46
Tier Three
Benchmark
1 100
15
0.030
0.007
0.067
80 - 9.0
Notes:
Italics indicate results above/outside benchmark range.
* - See General Permit for desa"on of Status (Tier One, Ter Two, etc.)

APPENDIX I
Submittal to North Carolina Department of Environmental Quality

b
-1

RECEIVED
FEB Q 8 2017
CENTRAL FILES
DWR SECTION
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO30000
Date submitted ). —(o ` 0
CERTIFICATE OF COVERAGE NO. NCGO30306 SAMPLE COLLECTION YEAR 2017
FACILITY NAME Jacobsen. A Textron Company SAMPLE PERIOD ❑ Jan -June ❑ Juiy-Dec
COUNTY Mecklenburg or ® Monthly' _ fmonthl
PERSON COLLECTING SAMPLES: NA DISCHARGING TO CLASS EJO'RW ❑HQ-WI.�` ❑Trout ❑IPPN�A.
LABORATORY: Shealy Environmental Inc. tab Cert. # NA ❑Z-o'flow Owater supply DsA
Comments on sample collection or analysis: ®Other C
None
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
Part A: Stormwater Benchmarks and Monitoring Results
M No discharge this period?'
outfall No.
Dae Sample
Collected'Collected'Collected'24
(mo/dd/yrl
amount. rainfallhour
tnd�
Total Suspended Solids
Standard units
Copper
Lead
Zint
Non-Poiar O&G/
Total Petroleum
�o�oro
Total Toxic
O� ni[ss
Benchmarks --= >
_
100 mg/L or So mg/L'
6.0 - 9.0
0.007 mg/L
0.03 mg/L
M067 mg/L
SS ma/L
1 mg/L
SING01
NA
NA
NA
NA
NA
NA
NA
NA
NA
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 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.
` 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 Rate: 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 TTp 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
(TTD), 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 im plementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
C HRIS WIM04GE
Name (Print name)
FACILITIES MANAGER
Title (Print title) , J
(Signature)
(Date)
Note: Results must be reported in numerical format Do not report Below Detection Limit, BDL, cPQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format'QU mglr 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 benchn-* you must Implement Tler 1, Ter 1; or Tier 3 responses See Geoer d Aermrt text_
Part 8: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No dischoroe this oeriod?z
outfall No.
c mte Sample
CoOeo l
(ma/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
airad mart =>
_
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 sU
NA
NA
NA
NA
NA
NA
Footnotes from Part A also apply to this Part 8
' See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 1111/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: if you report a sample value in excess of d re benchmark you must Implement Tier 2, 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 it SECTION B.
• TIER 3: HAS YOUR FAQUTY 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: Marcia Allocco -Mooresville Regional Office & Ken Pickle Central Office
Mail an ariginal and one ropy of this AMR Includina all 'W Discharge" reports within 30 datrs of recelot of the lab results for at end of monitorina period
In the case of `No Discharge' MppMl 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 a ccordance 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
-U-17
(S ature of Permlttt& (Date)
Permit Date:11/1/2012-1013112017 SWU-245, last revised 10/25/2012
Page 3 of 3

RECEIVED
JAN 11 2017
CENTRAL FILES
DVVR SECTION
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO30OW
Date submitted I - i T7
CERTIFICATE OF COVERAGE NO. NCGO30306 SAMPLE COLLECTION YEAR 2017
FACILITY NAME Jacobsen, A Textron Com env SAMPLE PERIOD ❑ la"une ❑ July -Der
COUNTY Mecklenburg _ _ or ® Monthly= _ fmonth)
PERSON COLLECTING SAMPLES: NA DISCHARGING TO CLASS [—]ORW L]HQW ❑Trout QPNA
LABORATORY: Shealy Environmental Inc_ Lab Cert. p NA QZero-flow Water Supply []SA
Comments an sample collection or analysis: ®Other C
None
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
R No dischorae this oenod;12
outfall No.
•
Date Sample
Collected' 1
Imo/dd/yri
24rainfall
amount,
Inches,
Total suspended Solids
pH,
Standard units
Capper
Lead
Zinc
Nan-Polar o&G/hour
Total Petroleum
Hydrocarbons
Total Toxic
OrganicInches,
Senchma►irs —s
_
1W mg/L or 50 mg/L'
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
is mg/L
1 mg/L
SYV001
NA
NA
NA
NA
NA
NA
NA
NA
NA
F-_
I Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
a 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.
' See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
'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.II/1/2012-10/31/2017
SWU-245, East revised 10/25/2012
Page 1 of 3
.1t

Facilities that incorporate a solvent management plan into the 5torrnwater 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 im plementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
CHRES Wt$SINGER
Name (Print name)
FACIt1TIES MANAGER -• _
Title (Prin " le /
(Signs e} (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 big reported in the format. "<M mft/L", where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L
Nate. If you report a sample valve in excess of the benchmark, you must implement Tier 1, rmr 2, or Tier 3 responses. see General Permit text.
Part 6: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No dischvrae this oerirrd K
Outfall No.
Date maple
fn0ected'
(-o/dd/yr)
24-hour rainfall
amour
tndies'
Non -polar O85/TPIi by
EPA 1664 (sIS*-HEM)
Total Suspended Solids
PH
Ben[hmarfa r->
_
-
is mg/I.
200 sng/L or 50 mg/L•
f.0 — 9.0 SU
NA
NA
NA
NA
NA
NA
Footnotes from Part A also apply to this Part B
' See General Permit text, Table 5, identifying the e5peaally sensitive receiving water classifications where the more protective benchmark applies.
Permit Date:li/1/2012-10/31/2017 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 'Ter 1, T%r 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 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUT -FALL? YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ®NO ❑
REGIONAL OFFICE CONTACT NAME: Marcia Allocco — Mooresville Regional Office & Ken Pickle - Central Offt g _
Mail an original and one mov of this DMRS including al! No Discharge" rraorts, within 30 days o f recelot of the lab results for at end of Mmitoring period
in the case of "No QWw e" 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:
'1 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 property gather and evaluate the information submitted. Based an 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.
am aware that thenare significant penalties for submittingfatse information, including the possibility of fines and imprisonment for knowing violations."
1 L7
S�
(Signature of Permittee) (Date)
Permit Date: 11/1/2017-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

i
��
V 0011Os/V
�_' A Textron tarnpanr
October 20'h, 2016
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
VIA CERTIFIED MAIL
NC(Y 0,3
o30
RECEIVED
OCT 242016
CENTRAL FILES
DWR SECTION
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of September 2016. These results showed above benchmark
concentrations for TSS, Zinc and Copper therefore we remain at Tier III status at Outfall 001
Sincerely,
Jacobsen, A Textron Company
Chris Wissinger
Facility/Environmental Manager
Attachments

Table 1
Stormwater Sample Compliance History
Jacobsen - Permit No: NCG030000 - (November 1, 2012 to October 31, 2017)
Year f Period I Sample Date I Sam le No.
LYear 1
January1, 2013 - June 30, 2013
April 4, 2013 1
July 1, 2013 - December 31, 2013
November 1, 2013 2
Year 2
Janua 1, 2014 - June 30, 2014
April 7, 2014
1 3
July 1, 2014 - December 31, 2014
November 17, 2014 1
4
Year 3
January 1, 2015 - December 31, 2015
January 12, 2015
5
March 27, 2015
6
October 28, 2015
7
Year 4
January 1, 2016 - June 30, 2016
February 23, 2016
S
February 23, 2016 - June 30, 2016
May 19, 2016
9
May 19, 2016 - December 31, 2016
September 26, 2016
10
Year 5
January 1, 2017 - June 30, 2017
r
1 11
July 1, 2017 - October 31, 2017
12
Notes:
1) Permit expires on October 31, 2017
2) Consecutive stormwater sampling events to be separated by 60 days unless in Tier 2 status,
or by permission from NCDENR.

Table 2
Historical Summary of Analytical Results
Jacobsen - Stormwater Outfall SWOO1
Permit No: NCG030000 - (November 1, 2012 to October 31, 2017)
Oulfali 0 SW001:
Sample Date
Parameter
Outfall
Status'
TSS (mgfll
Non -Polar OLG
(nw)
Total lead (mgll)
Total Copper
("n)
Total Zinc
( )
Total Rainfall
(in.)
pH (s.u.)
04/04/13
28
<5.9
<0.010
0.0065
0.075
1.0
6.76
Tier One
11/01/13
6.2
<4.7
<0.010
0.0067
0.065
1.0
9.1
Tier One
04/07/14
8.7
<5.0
0.0013
0.0089
0.060
2.25
7.8
Tier One
11/17/14
160
<4.8
0.0056
0.040
0.270
2,25
7.83
Tier TWO
01 /12/15
12
<4.8
<0.001
O.OD45
0.031
1.00
8.9
Der Two
03/27/15
12
<6.3
0.0012
0-0081
0.068
0.75
6.4
Tier Two
10/28/15
5.5
<5.3
O.DO2
0:0098
OA44
2.50
6.01
Tier Three
02/23/16
11
<5.6
<0.001
0.0038
0.082
1.75
6.50
Tier Three
05/19/16
13
<5.8
0.0011
0.0054
0.033
1.75
6.51
Tier Three
09/26/16
140
<6.7
0.003
0.020
0.110
1.50
7.36
Tier Three
Benchmark
100
15
0.030
0.007
0.067
--
6.0 - 9.0
Notes:
Italics indicate results above/outside benchmark range.
' - See General Permit for description of Status (Tier One, Tier Two, etc.)

APPENDIX 1
Submittal to North Carolina Department of Environmental Quality

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality Gen ral Permit No. NCGO30OW
Date submitted 10 -1 D- I V
CERTIFICATE OF COVERAGE NO. NCGO30306 SAMPLE COLLECTION YEAR 2016
FACILITY NAME Jacobsen, A Textron Company SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
COUNTY Mecklenbure _ or ® Month iyl September J(month)
PERSON COLLECTING SAMPLES: Tyler Rushin DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑pNA
LABORATORY: Shgaly Environmental Inc. tab Cert. A 329 ❑Zero -flow [-]water supply ❑sA
Comments on sample coUection or analysis: ®Other C
None
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
n Na disrharav this rwrind;"
ourm Na
Date Sample
Collected
Imo/dd/yrl
24-hour rainfallrainfallpH,Total
amo m
inches
Total Suspended SOIid3
Standard units
-
Lead
am
Non -Polar 0&6/
Total Petroleum
Hydrocarbons
Toxic
organ&
Benchmarks = >
_
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
2 mg/L
SW001
09/2Q16
1.5o
140 mg/L
7.36 su
0.020mglL
O.W3 mg/L
0.110 mg/L
c6.7 mg/L
—
` Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 for sampling periods with no discharge at any single outfall, 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 maybe eligible for a waiver of the rain gauge requirement.
` 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: ll/1/2012-10/31/2017 SWU-245, last revised 10/2S/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
(Tf0), 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."
CHRM WISSINGER
Name (Print name)
FACILMES MANAGER
Title (Print title)
10 `1.o-t(�
(Si ature) (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 mg/L', where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L
Note: tj you report o sample value In exrxss of the bendimark you must Implement Tier 1, Tier 2, or Tier 3 responses. See General Permittext
Part B: Vehide Maintenance Area Monitoring Results: only for facilities averaging > SS gall of new oil per month.
n No discharee this neriod?z
Outfail No.
Date Sample
Collected
(mo/dd/yr)
244mur rabdafl
amount,
inches,
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended SoOds
pH
Benchmurft =>
_
-
15 mg/L
1W mg/L or So mg/L*
6.0 — 9.0 SILO
NA
NA
NA
NA
NA
NA
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: 1111/2012-10/31/2017 5WU-24S, last revised 10/25/2012
Page 2 of 3

Nate: if you report a sample value in excess of the benchmark you must implement Tier 1, Tier Z, or Tier 3 responses. See General Permit text
FOR PART A AND PART B MONIT RING 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 11 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: Marcia Allocco — Mooresville Regional Office & Ken Pi kle— Central Office
Mail an original and one cony ai this DPWIX including all 'No Discharge" reports wh*_In 30 dew of Me efgt of the tab results for at end of monaming aertod
In the rose of No D&horW 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 ail 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.
am aware that there are significant pen "es for submitting faise information, including the possibility of fines and imprisonment for knowing violations."
it
(Signature of Permittee) (Date]
Permit Date: 11/i/2012-10/31/2017 . SWU-245, last revised 10/25/2012
Page 3 of 3

APPENDIX 2
Forms and Data to Be Included in Annex F of the Jacobsen Facility One Plan

L11

TIER ONE/TWO/THREE STORMWATER RESPONSE
DOCUMENTATION RECORD
Directions: Complete this form in entirety if an analytical benchmark is exceeded.
Records: The general stormwater permit requires that this form be maintained in the
facility's SWP3.
1. Compliance Dates Date
a. Samples collected 09/26/16__.
b. Sample results received 10/12/16
c. Tier stormwater management inspection due
(must be within 2 weeks of date above) 10/26/16
d. Tier stormwater management inspection
conducted
e. Implementation of selected actions deadline
(must be within 2 months of date "d" above)
11. Data
Current
Previous 1*
Previous 2*
Benchmark
Analytical
Results
Results
Outfall No.
Parameter
ValuelUnits
Result
Date:05119116
Date:02/23/16
Value/Units
TS!Zinc
100 m 1
140 mZA
13 m
l I m
SW001
Total Cr
0.007 m l
0.020
0.0054 m
0.0038 mgA
Total
0.067 m I
0.110 m
0.033 mgA
0.082 m I
* If Previous I result was also exceeded, then implement Tier Two monthly monitoring. Continue until current, Previous I and
Previous 2 results are all under the benchmark. If during permit term, analytical results indicate benchmark exceedance for any
specific parameter at any specific outfall four (4) times, the outfall is considered to be in Tier 3 and written notice should be sent to
the DWQ Regional Supervisor within 30 days of the fourth sampling result.
III. Inspection Results
Conduct an inspection of the drainage area to the outfall and record the date in "d" above. Person(s) conducting inspection
a. Iden ification of possible uses of exceedance
Mtn , romot-F FPzm 1-P �@ L-a)) Qur'kl �d f
b. Identification of possible controls/improvements entity at I one) 11
Enource Control f 2. Il % g i0 � t7 � 1
❑ Operational Controls
3 Physical Improvements
❑ Other
IV, implementation Record
Describe the actions completed to address the exceedance. if exceedance reoccurs in the next sampling, Tier Two actions are
mandated. }
V. Maintain this form in the S WP3 per general Stormwater permit requirements_

Semi-annual Stormwater Discharge Monitoriniz Report
for North Carolina Dhrision of Water Quality General Permit No. NCGO30000
Date submitted
CERTIFICATE OF COVERAGE NO. NCGO30306
FACILITY NAME lacpbsen, A Textron Company _ _„
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES: Tyler Rushin
LABORATORY: Shealy Environmental Inc. Lab Cert. 0 329
Comments an sample collection or analyses:
None
Part A: Sttumwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2016 _ _
SAMPLE PERIOD ❑ Jan -June July -Dec
or ® Monthly' September month
DISCHARGING TO CLASS ❑ORW []HQW Trout ❑PNA
[]Zero -flow []Water Supply []SA
®Other C
PLEASE REMEMBER TO SIGN ON PAGES I AND/OR 3 -311
n No discharge this oerind?2
OutfaO No.
Date Sample
Collected ,
(ma/dd/yrj
24 Iwur randa0
amount,
Inehess
Total Suspended Solids
�Copper
Standard units
Lead
nc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
organics
Benchmarks =>
-
-
1oo mg/L or 50 mg/L
6.0 - 9.0
O.OW nig/L
0.03 mg/L
0-067 mg/L
15 mg/L
1 mg/1
SWo01
09/26/16
1.50
140 mg/L
7.36 su
0.020 mg/L
0.003 mg/L
0.110 L
c6.7 mg/L
-
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceeciance for the same parameter at the same outfall.
' For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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
See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 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: 31/1/2012-10/31/2017 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 Ti'O 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."
CHRIS WiSSINGER
Name (Print name)
FACILITIES MANAGER
Title (Print title)
U 2C)
(Signature) (Date)
Note: Results must be reported in numerical format Do not resort Below Detection Limit, BDL, cpgL, Nan detect, ND, or other similar non numerical
format. When results are below the applicable limits, they must be reported in the format "d0( mitW, 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, 77er 2, or TFer 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > SS gal of new oil per month.
n No discharge this period?'
t)utia0 No
Lhte Sample
Collected
I—/dd/yr)
24 tour rainhil
amount,
Ines°
ch
Non -polar O&Gf 1PH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
BendrmarAs
LS mg/L
1W mg/L or SO mg/L*
6-0 — 9.0 SU
NA
NA
NA
NA
NA
NA
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: 11/l/2012-10/31/2017 5WU-245, last revised 10/75/2012
Page 2 of 3

Note: if you report a sample value in excess of the ben6marl4 you must implement 77er 2, 77er 2, or Tier 3 responses. See General Permit tent.
FOR PART A AND PART 8 MONITORING RESULTS:
A BENCHMARK FXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 DCCEFDANCES 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 ANYONE OUTFALL? YES ®NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFCE? YES O N0 ❑
REGIONAL OFFICE CONTACT NAME: Marcia Allocco — Mooresville Regional Office & Ken Pickle — Central Office
Mail an orfginol and one MR of this DMR, indudina all "No Disdrarae"reaom wrthin 30 days ofnpgdpt of the lab results fm at end of manittorlrra period
1n the case Q 'No Disd� re Wju M:
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 ail attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel property 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 gatheri a information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that there are significant pen es for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Le LA- — Ig)— zo"►la
(Signature of Permittee) (Date)
Permit Date: 1111/2012-10/31/2017 SWU-245, Last remised 10/25/2012
Page 3 of 3

3- Al
irciDERK
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit- t p: j f pu.n en.org f web mg ws./su f_p sw#tabb4
Permit No.: LVf JJ������/ or Certificate of Coverage No.: NJ1W-0J-3JV3L1-0Jfi-1
Facility Name: JaroUsen. A Textron Company
County: Mecklenburg -Phone No.
Inspector 1-, 41 0
Date of Inspection: _ cam- (o"
Time of Inspection:
�
Total Event Precipitation (inches): ___L it
704-587-5934
Was this a `Representative Storm Event" or'Measureable Storm Event' as defined by the permit?
(See information below.)
PT Yes ❑ No
Please verify whedier Qualitative Monitoring must be performed during a 'representative storm
evenCor'measureablestorm even t"(requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event.' However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
i.C1--) _--- q - 2 rn-i
(Signature of Permitfee or Designee)
Page 1 of 2
SWU-242, Last modified IOJ25/2012

L Outfall Description:
Outfall No. M01 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Unnaffled tributary ee Creek
Describe the industrial activities that occur within the outfall drainage area:
Turf maintenance enuij2mcnt manufacturfno_,_„_
Z Color. Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light medium, dark) as descriptors:
3. Odor-. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): -%
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 4 5
S. 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:
1Z3 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-
7.
8.
1 (D 3
Is there any foam in the stormwater discharge?
4 5
Yes
is there an oil sheen in the stormwater discharge? Yes
9. is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
5
S
Yes
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 10/25/2012

STORM EVENT DATA RECORD
Name of Facility: Jacobsen
Location: Outfall SWOO1
No. of Outfalls or Sample, Locations = I
Instructions. Fill in ALL blank boxes and lines
Time interval
Actual Time
Rain Gauge
(minutes)(')
in-}
Record _(mc P)
0
Storm Begins
0
0-30
Samples Collected
.0 : `
I ► J
No. of hours since previous measurable rain (0.1 inches) 7 2
pH of samples: Record pH of the outfall:
Date I' 7k -1 b
I.IM
Samples collected by ._ Tyr �P,r �v� V
Rain gauge reading taken by _CIr
pH meter read by:
Is Outfall Visual Monitoring Record attached for the outf ffl? e4
NOTES:
(1). Time zero (0) meatus the begiming of storm or as soon as discharge from sample point
becomes risible.
(2) The rain gauge level and time must be recorded at the end of the storm event.

NON -STORM WATER DISCHARGE ASSESSMENT AND CERTIFICATION
Jacobsen A Textron Com an ., Charlotte NC
Date of
Outfall Directly Observed
Test or
Evaluation
Daring the Test
(Identify as indicated on
the site map)
Method Used to
Test or Evaluate
Discharge
Describe Results from Test
for the Presence of Non-
Storm Water Discharge
identify Potential
Significant Sources
Name of Person
Who Conducted
the Test or
Evaluation
SW 001
CERTIFICATION
certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a y� stem designed to assure that qualified personnel properly gathered and evaluated the informaiion 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 fine and imprisonment for knowing violations.
A. Name & official'ritie (type or print)
B. Area Code and Telephone No.
C. Signature
D. Date Signed

PAGE NO.
k) ,2L*-7
YEAR
I�Mi
I®
®I
F1 o
ll�i•
I®
V
WUWM�WMWA
WOMAN-
®
w-
®
LWA A i
NOTE: Read age of rough the same time each day. Fan ty gauge after reading, unless stor3nwarer samples are
being collected. in t[vs evcr�t wait #ill storm is over and coIFect enure rain gauge reading for representative storm_
e-

PAGE NO. I
nett
'
MEASURED BY
MCI
,,
Elal
®
�
r
WAW
®
~
Era
_
I®
a
f
I
NOTE: Read gauge at roughly the same time each day. Empty gauge after reading, unles�6tormwvaier samples are
being collected In this event wait till storm is over and ool(ect enure rain gauge Ax-lgg��f , representative storm.

SHEALY ENVIRONMENTAL SERVICES, INC.
Report of Analysis
Jacobsen, Inc.
11524 Wilmar Blvd
Charlotte, NC 28241
Attention: Chris Wissinger
Project Name: Jacobsen Stormwater
Project Number.300-25
Lot Number:R127070
©ate Completed, 1011212016
Kelly M. Nance
Project Manager
r LABORATORY
ACCREDITATION
BUREAU
. RCCREDPI10nouron
This report shall not be reproduced, except in its entirety, without the written approval of Shealy Environmental Services, Inc.
The following non -paginated documents are considered part of this report: Chain of Custody Record and Sample Receipt Checklist.
Shealy Environmental Servioes, Inc, Page: 1 of 5
106 Vantage Point Drive Vilest Columbia, SC 29172 [phone] Fax [phone] www.shealylab.oam

SHEALY ENVIRONMENTAL SERVICES, INC.
SC DHEC No: 32010 NELAC No: E87653 NC DENR No: 329 NC Field Parameters No: 5639
Case Narrative
Jacobsen, Inc.
Lot Number: R127070
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary following this Case Narrative. The sample
receiving date is documented in the header information associated with each sample.
All results listed in this report relate only to the samples that are contained within this report.
Sample receipt, sample analysis, and data review have been performed in accordance with the most current approved NELAC standards, the
Shealy Environmental Services, Inc_ ("Shealy") Quality Assurance Management Plan (QAMP), standard operating procedures (SOPS), and Shealy
policies. Any exceptions to the NELAC standards, the OAMP, SOPS or policies are qualified on the results page or discussed below.
If you have any questions regarding this report please contact the Shealy Project Manager listed on the cover page.
Collection dateltime was provided by the client_
Page: 2 of 5
Shealy Environmental Services, Inc.
106 Vantage Point Drive west Columbia, 8C 29172 [phone] Fax [phone] www.shealylab.can

SHEALY ENVIRONMENTAL SERVICES, INC.
Sample Summary
Jacobsen, Inc.
Lot Number: R127070
Sample Number Sample ID Matrix Date Sampled Date Received
001 MGM Aqueous 09/2612016 OW 09/27/2016
(1 sample)
Shealy Environmental Services, Inc, Page: 3 of 5
108 vantage Point Drive West Cahnnbia, SC 29172 (803) 791-97D0 Fax [phone] www-sheatylab-cam

Inorganic non-metals
Client: Jacobson, Inc. Laboratory ID!R127070-001
Description: SW001 Matrix: Aqueous
Date Sampled:0912W2015 08"
Date Received:09127I2016
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Dada Batch
1 (TSS) SM 254OD-2011 1 09/2912016 1315 DMA 23244
1 (SGT - HEM (n) 16MB 1 10/05/2016 1014 ARP 23677
CAS Analytical
Parameter Number Meowd Result Q Pei. Units - Run
TSS SM 254OD-20 140 5.0 mglL 1
SGT - HEM (non -polar material) 1664E ND 6.7 mg1L - 1
POL = Practical quanbtation limit e = Detected m the method blank E = Quantitallon of comps exoseded me calibration range H = Out of holding tare
ND = Not detected at or above the PQL J = Estimated result < POL end? MDL P = The RPD between two GC COMM exceeds 40% N = Recovery is out or arteria
Where applicable, all 861 sample analysis are reported on a dry weight basis unless flagged WON 8 _W
Steaty Environmental Servia>a, Inc. Page: 4 of 5
106 Vantage Point Drive VOW ColumWa. SC 29172 [phone] Fax [phone] vwvwvr.sheaVtab.corn

ICP-MS
Client: Jacobsen, tnc. Laboratory ID:R127070-001
Description: SWO01 Matrix: Aqueous
Date Sampled�912612016 08"
Date Received:0912712016
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Data Batch
1 2002 200.8 1 09/29/2016 2041 BNW 09/29/2016 0936 23190
CAS
Analytical
Parameter
Number
Method
Result Q
PQL
Units
Run
Copper
7440-50-0
200.8
20
1.0
ug/L
1
Lead
7439-924
200.8
3.0
1.0
uglL
1
Zinc
7440-66-6
200.8
110
10
u91L
1
PQL = Practical quant atim Cant B = Detected in the malhod blank E = QuarmlaWn of aaapound exceeded the calihratim range H = Out Df hMwV Bare
ND = Not detected at or above the PQL J = Estimated resell < POL and a MDL P = The RPD between twD GC column exceeds 40% N = Rerrnrery is out of critens
Where applicable, ell sal sample ans"s are reported an a dry weight basis unless slagged WM 8 W
Shealy Environmental Services, Inc. Page: 5 of 5
106 Vantage Point Drive West Coiumbia, SC 29172 [phone] Fax [phone] www,sheal*b.com

Chain of Custody
and
Miscellaneous Documents
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.sheslytab.own

b,
.�
��.,�
R�

S
e�
ey Chaim of Custody Record
Shealy Environmental Services, Inc.
106 Vantage Paint Drive
West Columbia, $Oulh Carotlne 29172
Telephone No. (803) 791-97OD Fax No, (8O3) 791.9111
rwH.1hgety114,eom
Number
Client
Jacobson
Repou to Comas
SaniaoAh Dawson
Sampler (Printed kama)
Quaie No.
,address
11624 Wilmer U%d
TWitphonu No. i Fax No, i Cnull
samsntr►darserl flssanvvonmeruat,win
Wrybdt No.
page
Io! 1
City 81ate 171p Code
Charlotte NC M73
preservative
1. Unpros. e. HNO3 7. NaGH
. Na(7wlrrA 5. HCL
3. H2SO4 G. No Thlo.
1
1
1
NumWall'Conlainera
K
.1 1
D
Bottle
Pr*ect Name
JaaobAfto SW
1
y
4
Rresgrvalivo
VIEW
�r
l►rulect Number
p.0 Number
Matrix
Samote ID! Desi0pda
com5ined on one line)
"
�
rn
SWO01
G
X
X
X
X
Metals to be analyzed by
ICP-MS
rum,arourd Trine R enured (Prior lab approval rerlulrea 1br expedeso IATy
0maj,OX4 (2uh (Acm 6K-*
Sampre U+eppeal
Q Relum 10 t; o ❑ Disposal byr Lae
QC Roauiroments (Please Spec lyl
Pamela Hazefe lag( ilriat pn
8Non•Hntord (Yornmahia ❑5ldr,IRt m ll
polson (] Uh1nosm
M-
1, Reflammshed y t SaMPW
Dam
Time
1. Roodved by
L11"
Time
L Relingtiahed by
Date j
TUM
2. No by
Date
T+me
3. Ratingidshed by
Dote
nm
3. Rscalved by
Lze
Time
4. rleMglutsrrg4 by
Dale
a- Leba svY I�owirod try
t rme
-7J s
Nate: All samples are retained for six weeks from rowipt union other
arran etne11t6 are made
IL&B USE ONLY V 0
Received an Ice l'Ched) N1as PICA
RtaxlPi Tema
Tapp. Stank
Y�N
rfleelhre Date 06-27.2012
Y'
M
X
C_
^z

SHEALY ENVIRONMENTAL SERVICES INC.
sn-ry F—w Scrip. ►>K"
Dwwfta Mua bw: Maig 17SC-0
Means of rc m*
NPt art
E:ii+ci%bM1wrami ID14
Sample Receipt Checklist (SRC) Expar oats.
( cxrler laspcctvd byrcixi><:2+i iCt Lot #:� 27
❑ Clicst ❑ t 'PS ❑ FedFac © Other
iy;m���
ND
EE I
].
custodv"wS rr�ntonthecoald?
No
1dAel 12- If
matody seals wire presm, w,ere tbc„ intact and tmNmken?
pH strip 1D:l(, •111tA
Coolcr MQ )rigiaal teaveraturm +moue[ reeei
Method: anperatur Fllale ❑ .A
n
Method of ccmlaett- Wd ice
ED: _
410criv0d (corrected) tempemtura upon roc6pt:
utt
1 Bottles IR Uun lI? �G� IR QCarrection Factor. Q 'C
Blue Ice ❑ Dry Ice ❑ 'None
Yes ❑
No ❑
I,L4
3. If temper, MC of any cooler exceeded 6.0"C, wits Project 142nate3 notifiod?
PM was t etifwd by: phone! fantail 1 face-to-face (circle onc)-
Yes
No El
Nis 0
4. is the commercial
auzritx s PaqjRj slie uttae:ltaad to this form?
Yes
5. Were
cuswdv rymedurrs reli uishcd'rLxr.:ived followed"
Yes
No
6. Wese saniple
IDs listed on the COC?
?
Yes 13
1 No
7. Were SaWple
IDs listed on all sample containam?
Yes 0
Nu
R. Was Whk&n
date & time listed on the COG?
Yes
No
cnl
ion date & time lislal con ail sarn le comai -
[YC3
Ner
all
rta label ittfortnatian lD, time) a with t11c COC?
Yes
No
re
to be fumed listed on the COC?
Yes
No ❑
all
cn,
les arri%Te in the proper coutaincTn few ea& test andfor in good condition
oft, etc.)?
Yes
No
s
4eal
tc s le volume aieilable?
Ya
No
re all
am les racCiVW within'A the holding time or 0 hours, wbicheti� cames fast"
Yes ❑
No
e aft
samples coatainers rrtissirtp}ex+xs~ (.tin le one) sautplts net listed tm C(3C`7
Yes
No
NA
e bu
lag >" -size" ;'a"or 6mm in diameter) in T VOA viah*
Yes
No ❑
NA
e all
eaal(.>c(u'H£A4fnutrienl les feast. erd at a PH of c2?
Yes
No ❑
NA
I R. Were all
yanidc and -or aulftde samples rcecivcd at a H > 12?
Yes ❑
No t10
NA
19. Were all kpplic2ble
lorinc4
NH3,TKWcyanidd"phcnoI (<0.2mg+L) samples fret. of residtml
Yes
No o
NA Ef
211. Were c action tw [ores documented on the COC for NC 1CS?
Y� ❑
No ❑
!VA
21. 11`erPedi
carret-tl �
rcma*%'mqucsls (i.e. requested diluti&m. MSIMSD desiynations, etc...)
bexl from the COC into the oammenr section in LIMS?
22, n'as the
ote �ambcr uxer( taker] from the ootttairter label'?
sa wple Pce9ervadon (Must be oonwI
for an sample(s) incorneolly preserved or wi(b litzuUpace.)
sample (0 _
%am le receiving with
were received incanwdy prmcrwad and were adjusted acaatdingly in
(H2SO,,11NO3, HCl NaOQH) USilLK SR
R-"le(s) A
war received with bubbics :-6 mm in dianidex.
5ampks(g) wire rcccivud with TKC =-1.2 m&'L (If 021 is Nu) and wort
adjumed accordingly in sample eeceiving v ith .odium thiosul.Wtc (Naz5rU,) with Shealy TD:
SG Drinkirtg Water Pn jw Samples) pH aified to be 2 by Data
Sar le(s) wac not raeci at a pH of r2 and were adjusted accmfingly using SRk
Sample labels applied by:
Vuil`ie d by: Dee.-1 _, a,
Comet
Shealy Environmental Services, Inc.
106 Vantage Pant Drive West Columbia, SC 29172 [phone] Fax [phone] www.sheatylat).com

Parking Pass #69622763 for State Newspaper Parking I Guaranteed Parkin... Page 4 of 4
Description:
• This surface parking location is made up of 2 portions of the
parking lot of The State Newspaper offices and buildings. Patrons
will be directed to park in specific spaces upoon arrival.
How To Find It:
• Located on the south side of Shop Rd between Northway Rd and
George Rogers Blvd, this surface parking location is made up of
portions of the parking lot of the State Newspaper offices and
buildings. From George Rogers Blvd, customers would turn east
on Shop Rd. and right(south) into the location. From Bluff Rd
customers would turn north on Idlewild Blvd, then left(west) onto
Shop Rd and then left(south) into the access road for the location.
This location is also accessible from Key Rd via the same access
road.
'f'Py Qrya`�SR�
Fat 2 Fly Wing City
oW Williams -Brice Stadium
ti Qa S \
Qa 00
a
26 `r 4�4rP
ma South Carolina ksR
Department of Motor... a
.o°a amc sr` C..
cu
Gongle Map data n2016 Google
Plans Changed? ParkWhiz parking passes can be canceled for a full
refund up until your arrival time. Use the "Cancel Your Parking" link in
your confirmation email.
>
v
https://www.parkwhiz.com/ticket/69622763/?u=d5O9f8b9&utm_source--tr... 10/ 19/2016

Parking Pass #69622763 for State Newspaper Parking I Guaranteed Parkin...
Page 1 of 4
PARKWHIZParking Pass
Your ParkWhiz Pass ID #:
69622763
You will be asked for this number to validate your parking
■ ■
How to Park:
qI
1. Show ParkWhiz
Pass to the
attendant
2_ Park in any spot
not marked
"Reserved"
Need Help? Call
ParkWhiz:
[phone]
6am-8prn CT every day
Park anytime after
9:00 am
Saturday Oct 22nd
Event:
Exit anytime before
+3 hours
after event
Saturday Oct 22nd
Mass Minutemen at South Carolina
Gamecocks Football
Location:
https:Hwww.parkwhiz.com/ticket/69622763/?u=d509f8b9&utm_source=tr... 10/19/2016

Semi-annual Stormwater Discharge Monitorina Report
for North Carolina Division of Water Quality General Permit No. NCGO30000
Date submitted. f,ly,- , s rk_�_D I if
CERTIFICATE OF COVERAGE NO. NCGO30306 SAMPLE COLLECTION YEAR 201
FACtUTY NAME Jacobsen, A Textron Company _ SAMPLE PERIOD ❑ Jan -June July -Dec
COUNTY Mecklenbltrg or ® Monthly' April _ (Monthl
PERSON COLLECTING SAMPLES: NA DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY: NA Lab Cert_ DNA ❑I.ero-flow ❑Water Supply QSA
Comments on sample collection or analysis: ®Other C
None
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
M No discharge this neriod?1
Outfav No,
Date Sample
i
Collected
(mo/dd/yr)
24-hour rainfall
amount.
Inches'
Total Suspended Solids
PH.
Standard units
Copper
lead
Ilrrr
Non-POtar O&G/
Total Petroleum
Hydrocarbons
Total Snack
Organi6
Benchmarks -- =>
_
-
100 mg/L or 50 mg/L
&0 — 9.0
0.007 mg/L
0.03 mg/L
0A67 mg/L
15 mg/L
1 mg/L
SW001
NA
NA
AEA
NA
NA
NA
NA
NA
' 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 ou"I, you must still submit this discharge monitoring report with a checkmark here.
3 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.
' 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
RECEIVED
DEC a 7 2016
CENTRAL FILES SWU-245, lase revised 10/25/2012
DWR SECTION Page Iof3

Facilities that incorporate a solvent management plan into the 5tormwater 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 5tormwater Pollution Prevention Plan."
CRRIS WLSSINGER
Name (Print name)
FACULMES MANAGER
Title (Print title)
zvt�
(Sig re) (Date)
Note: Results must be reported in numeriral formaL 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 "<= 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 Z or Tier 3 responses. See General Pemrit text
Part B. Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this period??
Outw No.
Date Sample
Collected'
{mo/dd/yr}
244mur rainfall
amount,
Inches'
Non -polar OAG/TPH by
EPA 16641SGT-HEM)
7ota1 Suspended Solids
pH
Benchmarks =—>
_
15 mE/L
IW mg/L or 50 mg/L•
6.0 — 9.0 Su
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017 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 71er 1, Tier 2, or Tier 3 responses. See General Permit text.
FQR 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 QUTFALL 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:
Mail gaAdginal and one copy of this Wk Indudina all -No Dischume'repartx within 30 days of receipt of the lab rlesufls /orat end of monftori4rta �eriad
in the rose of No Discharge' reports) to:
Derision of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFIUMON 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
r�^ y�r6
(Signature of Permittce)CA�;?
(Date)
Permit Date: 111/i/2012-10/31/2017 SWU-245, last revised 10/2S/2012
Page 3 of 3

RECEIVED
SEP 12 201E
CENTRAL FILES
DWR SECTION
Semi-annual Stormwater DischaMe Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO30000
Date submitted
CERTIFICATE OF COVERAGE No. NCG030306
FACILITY NAME Jacobsen. A Textron Company
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES: NA
LABORATORY: NA Lab Cert. #NA
Comments on sample collection or analysis:
None
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR _ 201 0
SAMPLE PERIOD ❑ Jan-Jurte July -
or ® MonthW_f ►!P (month)
DISCHARGING TO CLASS ❑w ORi - it []Trout ❑PNA
❑Zero -flow ❑Water Supply ❑m
®Other C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
M No discharae this nenod?Z
Outfa{I No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non-1 oLar 0&6/
Total Petroleum
hW rbons
Taft)Tmde
ownics5
Benchmarks --=
_
1W mg/L or 50 mg/L
6.0— 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
25 mg/L
1 mg/L
SV=2
NA
NA
NA
NA
NA
NA
NA
NA
'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
7 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 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.
`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:il/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.'
CHRIS WISSINGER
Name (Print name)
FAC UTIFS {MANAGER
Title (Print titiel
(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 retorted in the format,'-= mr.W where )O( is the numerical value of the detection
limit, reporting limit, etc. in mg/L
Note. If your report a sample value in excess of the bendtmant you must implement 'rer 1, Tler 2, or Ter 3 responses. See Genera! 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.
bateSample-
CO„ecbedI
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G/M by
EPA 16641SGT44EM)
Total suspended Solids
PH
Berx*nu rks =>
15 mg/L
100 mg/L or So WU
6.0 -- 9.0 SU
NA
NA
NA
NA
NA
NA
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: 1111/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2of3

„, •
Note, If you repot a sample value in excess of the benchmark you must implement Tier 1, 77er Z 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 It 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 ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES Q NO
REGIONAL OFFICE CONTACT NAME:
Mallon orfainal and one ropy of this AMR includina all No DiscbgMe” Moons. wWdn 30 don pf receipt of the lob results for at end of monitoring period
In the case of "No Discharge" reporur )
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 taw, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel property 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.
am aware that there are significant gRtfalties for submitting false information, including the passibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/2S/2012
Page 3 of 3

F§LCCOpb
RECEIVED
AUG 02 Zm
CENTRAL FILES
CWR SECTION
Semi-annual Stormwater Discharge Monitoftna Report
for North Carolina Division of Water Quality General Permit No. NCGO30000
Date submitted
CERTIFICATE OF COVERAGE No. NCG030306
FACILITY NAME Jacobsen, A Textron Company
COUNTY Mecklenburg_
PERSON COLLECTING SAMPLES: NA
LABORATORY: NA Lab Cert. #NA
Comments on sample collection or analysis:
Part A. Stormwater Benchmarks and Monitoring Resutts
SAMPLE COLLECTION YEAR . ,t PJ (P
SAMPLE PERIOD ❑ ian-June I I July-uec
11 s/ or ® Monthly'_ 'Zr V 1 ymonth
D15C11ARGING TO CLASS ❑ORW Li QW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑sA
®Other C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
Fa No dischorae this nerind?�
Outfall No.
Date Sample
Collected'
Collected'
(mo/dd/yri
244mur rainfall
am
Total Suspended Solids
Total
Standard units
CoP�
Lead
Zinc
Non-Polar OAG/
T� rocarbons
Total Toxic
O rs
Emchmorks
wo mg/L or so mg/L
6.0 — 9.0
0.W7 mg/L
0.03 mg/L
0.W7 mg/L
15 mg/1
1 mg/L
SW001
NA
NA
NA
NA
NA
NA
NA
NA
—
' Monthly sampling linstead of semi-annual) must begin with the second consecutive benchmark exceedanee for the same parameter at the same outfali.
'For sampling periods with no discharge at any single outfall, 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.
`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 i 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
(ITO), 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."
CHRIS WISSINGER _
Name (Print name)
FACILnIE-MANAGER
Title (Print title)
(S aturel (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, thgX must be reported in the f2MRj. "-= mdV 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 lmph mint 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.
❑ No dischorcge this period
OutFan No.
Date Sample
Collected'
1—Mil/yr)
24-hour rainfau
amount.
Inches -'EPA
Non -polar O&Gf" by
1664 {SGT-HEM)
Total Suspended Sorrds
ptf
Bendvnarks =_>
_
IS mg/L
1W mg/L or So mg/V
6.0 — 9.0 SU
NA
NA
NA
NA
NA
NA
Footnotes from Pant 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: 11/l/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: Ifyou report a sample value in excess of the benabmarl4 you must implement Tier 1, Trer 1; or Wer 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 ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mallon adainal and one corny of this DM& Induding all 'No Discharge' reports wiihin 30 days of receipt of the lab resufts�tor at end of manitarina oerlod
in the case of "No Dfsdwme" rcoartsl 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.'
f G
(Signature of Perrnittee) {Date)
Permit Date_ 11/1/2012-10/31/2017 SWU-245, last revised 10/2S/2012
Page 3 of 3

am<sj V
addMP-- A Texcra+ cc-wny
July, 29' 2016
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
VIA CERTIFIED MAIL
RECEIVED
AUG 02
CENTRAL FILES
DWR SECTIC?I<i
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of July 2016. Stormwater samples from a measurable storm event
were not collected this monthly period due to precipitation events occurring after business hours or on
weekends.
Sincerely,
Jacobsen, A Textron Company
Chris Lngers
Facility/Environmental Manager
Attachments

19
� L� OEN Table 2
,'�N 1VrZ\ Historical Summary of Analytical Results
b\NR Jacobsen - Stonnwater Outfall SW001
Permit No: NCGO30M - (November 1, 2012 to October 31, 2017)
Outfall 0 SW001;
V3 OD CD� e
Sample Data
Parameter
Outfall
S��.
TSS (m9n)
Non -Polar OSG
(nVn)
Tonal Lead (mgll]
Total Copper
(�)
Total Zinc
(rn9/i)
Total Rainfall
(in.)
PH (s.u.)
04/04/13
28
<5.9
<0.010
0.0065
0.075
1.0
6.76
Tier One
11/01/13
6.2
<4.7
<0.010
0.0067
0.065
1.0
9.1
Tier One
04/07/14
8.7
<5.0
0.0013
0.0089
0.060
2.25
7.8
Tier One
11/17/14
160
<4.8
0.0056
0.040
0.270
2.25
7.93
.Tier Two
01/12/15
12
<4.8
<0.001
0.0045
0.031
1.00
8.9
Trer Two.
0327/15
12
<6.3
0.0012
0.0081
0068
0.75
6.4 t.
Trer Two
10281.1.5
5.5
<5.3
0.002
0.0098
0.044
2.50
8.01
Tier Three
�223/16
11
<5.6
<0.001 1.
0.0038 1
0.082 1
1.75
6.50
Tier Three
05/19/16
f 13 1
<5.8
0.0011
0.0054
0.033
1.75
6.51
Tier Three
Benchmarirl?
100 1
15
0.030 1
0.007
0.06-1
6.0 - 9.0
-
Notes:
Italics indicate insults aboveloutside benchmark range.
• - See General Permit for description of Status (Tier One, Tier Two, etc.)

JACOBSEN STORMWATER SAMPLE RESULTS
May 19, 2015
Discharge
Characteristics
Benchmark
Concentration
Analytical. Ccentrations
Outfall SW@01
Total Suspended Solids
(mg/1)
100
13
Non- Polar Oil and Grease
m 1
15
c5.$
Total Lead (mg/1)
0.030
0.0011
Total Copper (mg/1)
0.007
0.0054
Total Zinc (mg/1)
0.067
0.033
Total Rainfall (in.)
—
1.75
PH (s.u.)
6.0 — 9.0
6.51
III SUBMITTAL
The results of the May 2016 stormwater monitoring must be submitted to the North Carolina Department of
Environmental Quality (NCDEQ) on or before June 27, 2016. The information to be sent to NCDEQ,
including a sample cover letter, is included in Appendix 1. The originals and one (1) copy of only the following
items are required to be sent to NCDEQ:
• Completed and signed May 2016 Stormwater Discharge Outfall (SDO) Monitoring Report;
• Ensure that the date submitted section at top of the form is completed before mailing
All forms are to be signed by the company signatory authority in the places indicated. Mail the original
and one (1) copy of the signed information by certified mail to NCDEQ at:
Division of Water Quality
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
2

IV ACTIONS
In accordance with the discussions with the NCDEQ, Central Office representatives, the facility is required to
continue monthly monitoring for three (3) consecutive months and report the results of the sampling events at
the conclusion of the third sampling event to the NCDEQ Stormwater Program (to the attention of Mr. Ken
Pickle). With two (2) of the required three (3) sampling events having been completed (albeit not
consecutively due to intensity of precipitation events providing an actual discharge from the facility
stormwater pond outfall SWOO1), the one remaining event should be conducted similar to all other sampling
events in that all parameters (not just metals) need to be analyzed in conjunction with visual stormwater
monitoring and other associated inspections (including tier inspections to be conducted within 2 weeks of
receiving this package) as required by the General Permit.
Clean and remove debris from the stormwater pond and the outfall pipe as required and continue the routine
cleaning schedule implemented for the stormwater pond and outfall areas to minimize the potential for
benchmark value exceedance at OutfalI S WOO I .
Conduct maintenance and calibration of the pH meter according to facility ISO protocols and meter
manufacturer instructions. Ensure that the calibration liquid is not used past its expiration date.
Ensure that the sampling personnel are wearing clean latex gloves while sampling and that samples are
collected from the middle of the stormwater pond outlet pipe so as to minimize the amount of sediments
collected in the sampling container. The pH of the stormwater sample and the rain gauge should be measured
durin the sampling event in the field to ensure that the sample pH outside the benchmark range is not due to
the actual pH of the precipitation.
In addition, due to the close proximity of the stormwater outfall to the unnamed tributary to Steele Creek,
ensure that samples are collected only from the stormwater pond discharge to avoid any cross contamination
which could lead to benchmark exceedance. There have been reported instances of the velocity of the
tributary stream flow pushing water back into the discharge pipe which could lead to cross contamination and
this should be avoided at all costs. If such a situation exists, stormwater samples should not be collected as
this will not be representative of the facility stormwater.
Complete the Stormwater Event Data form such that the rainfall record from rain gauge is observed and noted
when samples are collected and when the precipitation event has ended. Rainfall amounts during sampling
events are required to be submitted to NCDEQ through the DMR form and this will allow an accurate record
of the measureable storm event. This is especially critical in lieu of the monthly sampling requirements to
obtain relief from the Tier III status of the facility. In addition ensuring that daily rainfall (including no
rainfall) is documented in the Daily Rainfall Log will provide documentation to validate no discharge
scenarios when stormwater sampling could not be conducted for the required monitoring period.
Review the past stormwater sampling report memos for additional action items for maintaining the metals in
the facility stormwater under benchmark concentrations for source controls.
V RECORDS
The results of stormwater monitoring must be included in your facility's Stormwater Pollution Prevention Plan
(SWP3). All materials to be included in the SWP3 are attached in Appendix 2. Included are:
3

• May 2016 Stormwater Discharge Outfall Qualitative Monitoring Report;
• May 2016 Stormwater Discharge Outfall Analytical Monitviiing Report; (Sign and place in Annex)
• Laboratory Analysis Report; ,z
• Storm Event Data Record
• Annual non-stormwater discharge assessment and certification
Place a copy of the stormwater records at the end of Annex F of your facility's One Plan.
We appreciate the opportunity of providing stormwater sampling services to Jacobsen. Please don't hesitate to
contact us at 704-374-5393 with any questions or comments.
4

Table 1
Stormwater Sample Compliance History
Jacobsen - Permit No: NCG030000 - (November 1, 2012 to October 31, 2017)
Year Period Sample Date Sample No.
Year 1
January 1, 2013 - June 30, 2013
Aril 4, 2013
1
July 1, 2013 -December 31, 2013
1 November 1, 2013
2
Year 2
January 1, 2014 - June 30, 2014
1 4ril 7, 2014
3
July 1, 2014 -December 31, 2014
1 November 17, 2014
4
Year 3
January 1, 2015 - December 31, 2015
January 12, 2015
5
March 27, 2015
6
October 28, 2016
7
Year 4-February
Janua 1, 2016 - June 30, 2016
February 23, 2016
8
23, 2016 - June 30, 2016
May 19, 2016
9
TBD - June 30, 2016
10
July 1, 2016 - December 31, 2016
11
Year 5
January 1, 2017 - June 30, 2017
12
July 1, 2017 - October 31, 2017
1
1 13
Notes:
1) Permit expires on October 31, 2017
2) Consecutive stormwater sampling events to be separated by 60 days unless in Tier 2 status,
or by permission from NCDENR.

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030OOe/ze, AM%
Date submitted - '16
CERTIFICATE OF COVERAGE NO. NCG030306 SAMPLE COLLECTION YEAR-/1*201 b
FACILITY NAME Jacobsen A Textron Company `�� MPLE PERIOD ❑ Jan�une ❑ July -Dec Pk
COUNTY Mecklenburg RE,CE �J `or ®Monthly' May _ (month)
PERSON COLLECTING SAMPLES: NA DISCHARGING 0 CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY: NA Lab Cert. #NA JUL11 2416 ❑Zero -flow _ []Water Supply ESA
Comments on sample collection or analysis: CENTRAL FILES ®Other C
None C)WR SECTION
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3
Part A: Stormwater Benchmarks and Monitoring Results
No discharge this period?z
Outfall No.
Date Sample
p
Collected"
(mo/dd/yr)
24-hour rainfall
amount,
Inchee
Total Suspended Solids
p H,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organlcs5
Benchmarks ===>
_
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
MOM
NA
NA
NA
NA
NA
NA
NA
NA
--
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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.
5 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 5WU-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
(71`0),1 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."
CHRIS WISSINGER
Name (Print name)
FACILITIES MANAGER _
Title (Print title)
J,
(Signa re) (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 malt". 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 > S5 gal of new oil per month.
❑ No discharge this period?2
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
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017 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.
0 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 -
Mall an orlainal and one coon of this DMR, Includina all "No Discharae" report , within 30 days of re lot of the lab results for at end of monitorina period
In the case of "No Dlscharae" 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 are significant penalties submitting false information, including the possibility of fines and Imprisonment for knowing violations."
(Signature of
-11 V/ ip
(Date
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

Semi-annual Stormwater Discharge Monitoring -Report
for North Carolina Division of Water Quality General Permit No. NCG0A'P.,t
Date submitted
CERTIFICATE OF COVERAGE NOACG030306
FACILITY NAME Jacobsen, A Textron Company
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES: NA
LABORATORY: NA Lab Cert. #N
Comments on sample collection or analysts:
None .-
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR
SAMPLE PERIOD ❑ Jan-Jti
or ® Mo tF
r � ��i��RGING TO CLASS
�
WY - Q' 20%
Cnpy
U July -Dec
April !month]
TRW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply [:]SA
®Other C
MR SECTION PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 3
INFORMATION PROCESSING UNIT
® No discharge this period ?2
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
Organics
Benchmarks ==_>
_
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0,067 mg/L
15 mg/L
1 mg/L
SW001
NA
NA
NA
NA
NA
NA
NA
NA
--
s Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
a For sampling periods with no discharge at any single outfall, 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.
"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 dlrectiy responsible for managing compliance with the permit monitoring requirement for total toxic organics
(770), 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."
CHRIS WISSINGER _ ._
Name (Print name)
FACII itIES MANAGER
Title (Print title)
(Signature) (Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, 8DL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format. "<M mall", 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 > SS gal of new oil per month.
❑ No discharge this period?1
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM}
Total Suspended Solids
pH
Benchmarks
15 mg/L
100 mg/L or SO mg/L*
6.0 — 9.0 SU
NA
NA
NA
NA
NA
NA
Footnotes from Fart 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; 11/1/2012-10/31/2017 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 Z, or Tier 3 responses. See Genera! Permit text.
FOR PART A AND PART B MONITORING RESULT :
* 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 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDEN S FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES 2 NO ❑
REGIONAL OFFICE CONTACT NAME: N1 a l' i 4. $1I,r aC,t1-, ILP, c1 P► G k P
Mail an orfainsepm InG&gng11 " o Dischgme" Morts. W.Min 30 days of receipt of the! or at end of moaftdner
In fhe Base of "No Dischame" resorts) 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 _ ER PORT D:
"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
Permit Date: 11/1/2012-10/31/2017
C5 - ?-,- I
(Date)
SWU-245, last revised 10/25/2022
Page 3 of 3

P/Z't � _. .14-4
to��y
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO30000
Date submitted LI-1-Ili
CERTIFICATE OF COVERAGE No. NCGO30306 SAMPLE COLLECTION YEAR 201
FACILITY NAME Jacobsen A Textron Cam Rny SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
COUNTY Mg!;klenburg or ® Monthly' April _ (mot1rhJ
PERSON COLLECTING SAMPLES: NA DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout PNA
LABORATORY: NA Lab Cart. #NA ❑Zero -flow ❑Water Supply
Comments on sample collection or analysis: ®Other C
None
Part A. Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
5a No dischorae this neriod ?'
O utfall No.
Date Sample
Collected i
Imo/dd/yr)
24 hour rainfall
amount,
Inrlsas'
Total Suspended Solids
PH'
Standard units
Copper
Lead
zinc
Non -Polar O&G/
Tot l m
TO ITOXIC
Benchmarks
100 mg/L or SO mg/l
6.0 — 9.0
0.007 nigh
0-03 mg/L i
OA67 mg/L
15 mg/L
1 mg/L
Swool
NA
NA
NA
NA
NA
NA
NA
NA
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance tar the same parameter at the same outtail.
j For sampling periods with no discharge at any single outfall, 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.
5 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 bate: 11/1/2012-10/31/2017 swu-245, last revised 10/25/2012
Page i 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
MID), 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."
CHRIS WFSSINQER
Name (Print name)
FACILMES MANAGER _
Title (Print ' le) —
(Si ature) (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 he reported In the format. "<XX n.WL', where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L
Note: If you report a sample value In ezoess of the bendrmarfr, you must implement 77er 1, Tler 2, or Tier 3 responses. See General Permit text
Part B: Vehide Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new rn7 per month.
n No dischoree this neriod?Z
otifto No.
Date Sample
CDOected 1
(rno/dd/yr)
24-hour rainfall
amount.
Inches'
Non -polar O&GtMH by
EPA 1664 (SGT-HEM)
Total St6pertded Solids
PH
Bendrmorks = >
_
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.o Su
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

NOW: If you report a sample value in excess of the benchmark, you must implement 'Ter 1, Tier 4 or Fier 3 responses. See General Permit text -
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
. 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 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:
a
Mail an orfalaal and one ropy of this AMIt including all No DischaMe-" M?eE!& within 30 days of recefat of the lab resaJts for of -end of monitar_lnQ rind
In the case of 'No Dlscba ems:
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 property 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.'
�-
f / v � �--, �4 J
(Signature of Permitteej (Date)
Permit Date: ll/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3of3

A Textron Company
VIA CERTIFIED MAIL
April I `; 2016
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of March 2016. Stormwater samples from a measurable storm event
were not collected this monthly period due to precipitation events occurring after business hours or on
weekends.
Sincerely,
Jacobs , A Textron Company
r
Chris Wissinger
Facility/Environmental Manager
Attachments

6 FISS h06"o 30306 26�6
ENVIRONMENTAL
VIA EMAIL
MEMO
TO:
FROM:
DATE:
SUBJECT:
CHRIS WISSINGER
JACOBSEN, A TEXTRON COMPANY
SAMANTH DAWSON
FISS ENVIRONMENTAL SOLUTIONS INC.
MARCH 8, 2016
STORMWATER MONITORING RESULTS (FEBRUARY 2 0
FISS JOB NO.300-25
MAR 17 2016
pVVTL FILES!
R SECTIO
1 BACKGROUND
Attached are the analytical results for the stormwater samples collected at Jacobsen on February 23, 2016. The
samples were collected at the stormwater pond outfall S W001. The February 2016 stormwater analytical
monitoring serves as the eighth sampling event conducted at the facility under the General Permit issued
November 1, 2012 and effective till October 31, 2017.
The facility is currently under a Tier III status for consecutive exceedances of Total Copper based on previous
stormwater sampling events during the term of this permit. Based on correspondences with representatives of
the North Carolina Department of Environmental Quality (NCDEQ) with regards to the tiered status of the
facility, Jacobsen is required to conduct three (3) monthly stormwater sampling events in order to obtain relief
from monthly monitoring requirements as stipulated for Tier III status. These sampling events will serve as
confirmatory samples after installation of source controls to mitigate possible sources of metals contribution in
the facility stormwater. A copy of this correspondence is attached to this memo report. The February 2016
stormwater sampling event serves as the first among three (3) confirmatory stormwater sampling events.
Tables 1 and 2 shows the schedule and historical record of stormwater sample requirements and analytical
results for the current general permit term.
ll RESULTS
Based on the laboratory results from the February 23, 2016 sampling event, Jacobsen has exceeded the Total
Zinc benchmark at Outfall SWO01 and remains in Tier III status. The analytical results and the respective
benchmark concentrations are shown in the table below.
7251 Pineville Matthews Road. FISS Environmental Solutions, Inc. Main: 704-374-5400
Suite 300, Charlotte NC 28226 Fax: [phone]

JACOBSEN STORMWATER SAMPLE RESULTS
February 23, 2015
Discharge
Characteristics
Benchmark
Concentration
Analytical Concentrations
Outfall SW001
Total Suspended Solids
(mg/1)
100
11
Non- Polar Oil and Grease
(mg/1)
15
<5.6
Total Lead (mg/1)
0.030
<0.001
Total Copper (mg/1)
0.007
0.0038
Total Zinc (mg/l)
0.067
0.082
Total Rainfall (in.)
—
1.75
pH (s.u.)
6.0 — 9.0
6.5
III SUBMITTAL
The results of the February 2016 stormwater monitoring must be submitted to the North Carolina Department
of Environmental Quality (NCDEQ) on or before April 2, 2016. The information to be sent to NCDEQ,
including a sample cover letter, is included in Appendix 1. The originals and one (1) copy of only the following
items are required to be sent to NCDEQ:
• Completed and signed February 2016 Stormwater Discharge Outfall (SDO) Monitoring Report;
• Ensure that the date submitted section at top of the form is completed before mailing
All forms are to be signed by the company signatory authority in the places indicated. Mail the original
and one (1) copy of the signed information by certified mail to NCDEQ at:
Division of Water Quality
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
AA

IV ACTIONS
Per discussions with the NCDEQ, Central Office representatives, the facility is required to continue monthly
monitoring for three (3) consecutive months and report the results of the sampling events at the conclusion of
the third sampling event to NCDEQ. These sampling events should be conducted similar to all other sampling
events in that all parameters (not just metals) need to be analyzed in conjunction with visual stormwater
monitoring and other associated inspections (including tier inspections to be conducted within 2 weeks of
receiving this package) as required by the General Permit.
Clean and remove debris from the stormwater pond and the outfall pipe as required and continue the routine
cleaning schedule implemented for the stormwater pond and outfall areas to minimize the potential for
benchmark value exceedance at Outfall S W 00 L
Conduct maintenance and calibration of the pH meter according to facility ISO protocols and meter
manufacturer instructions. Ensure that the calibration liquid is not used past its expiration date.
Ensure that the sampling personnel are wearing clean latex gloves while sampling and that samples are
collected from the middle of the stormwater pond outlet pipe so as to minimize the amount of sediments
collected in the sampling container.
In addition, due to the close proximity of the stormwater outfall to the unnamed tributary to Steele Creek,
ensure that samples are collected only from the stormwater pond discharge to avoid any cross contamination
which could lead to benchmark exceedance. There have been reported instances of the velocity of the stream
flow pushing water back into the discharge pipe which could lead to cross contamination and this should be
avoided at all costs. If such a situation exists, stormwater samples should not be collected as this will not be
representative of the facility stormwater.
Complete the Stormwater Event Data form such that the rainfall record from rain gauge is observed and noted
when samples are collected and when the precipitation event has ended. Rainfall amounts are required to be
submitted to NCDEQ through the DMR form and this will allow an accurate record of the measureable storm
event. In addition, ensure that daily rainfall (including no rainfall) is documented in the Daily Rainfall Log in
order to provide documentation to validate no discharge scenarios when stormwater sampling could not he
conducted for the required monitoring period.
Review the past stormwater sampling report memos for additional action items for maintaining the metals in
the facility stormwater under benchmark concentrations.
V RECORDS
The results of stormwater monitoring must be included in your facility's Stormwater Pollution Prevention Plan
(SWP3). All materials to be included in the SWP3 are attached in Appendix 2. Included are:
• February 2016 Stormwater Discharge Outfall Qualitative Monitoring Report;
• February 2016 Stormwater Discharge Outfall Analytical Monitoring Report; (sign and place in
Annex)
• Laboratory Analysis Report;
• Storm Event Data Record
3

• Rainfall data for facility.
• February 2016 NCDEQ Correspondence
Place a copy of the stormwater records at the end of Annex F of your facility's One Plan.
We appreciate the opportunity of providing stormwater sampling services to Jacobsen. Please don't hesitate to
contact us at 704-374-5393 with any questions or comments.
4

Table 1
Stormwater Sample Compliance History
Jacobsen - Permit No: NCG030000 - (November 1, 2012 to October 31, 2017)
Year Period Sample Date Sample No. 71
Year 1
January 1, 2013 - June 30, 2013
Aril 4, 2013
1 1
July 1, 2013 - December 31, 2013
November 1, 2013
1 2
Year 2
January 1, 2014 - June 30, 2014
1 Aril 7, 2014
1 3
July 1, 2014 - December 31, 2014
1 November 17, 2014
1 4
Janua 12, 2015 5
Year 3 January 1, 2015 - December 31, 2015 March 27, 2015 6
October 28, 2015 7
Year 4
January 1, 2016 - June 30, 2016
February 23, 2016
8
February 23, 2016 - June 30, 2016
9
TBD - June 30, 2016
10
July 1, 2016 - December 31, 2016
11
Year 5
January 1, 2017 - June 30, 2017
12
July 1, 2017 - October 31, 2017
13
Notes:
1) Permit expires on October 31, 2017
2) Consecutive stormwater sampling events to be separated by 60 days unless in Tier 2 status,
or by permission from NCDENR.

Table 2
Historical Summary of Analytical Results
Jacobsen - Stonrnrater Outfall SWOOi
Permit No: NCGO30000 - (November 1, 2012 to October 31, 2017)
Oulfall9 001:
Sample Date
Parameter
Outfall
saw.
TSS {mgA)
Non -Polar OSG
(�)
Total Lead (MO)
Total Copper
Total
Total 21nc
(�)
Total Rainfall
(in)
pH [s.0 }
04/04/13
28
<5.9
<0.410
0.0065
0.075
1.0
6.76
Tier One
11/01/13
6.2
<4.7
<0.010
OA067
0,065
1.0
9.1
Tier One
04/07/14
8.7
<5.0
0.0013
0.0089
0.060
2.25
7.8
Tier One
11 /17/14
160
<4.8
0.0056
0.040
0.270
2.25
7.83
Tier Two
01/12/15
12
<4.8
<0.001
0.0045
0.031
1.00
8.9
Trer TWO
03/27/15
12
<6.3
0,0012
0.0081
0.066
0.75
6.4
Tier Two
10128/15
5.5
<5.3
0.002
0.0098
0.044
2.1
6.01
TFer Three
02123M 6
11
C5.6
<0.001
0.0038
0.082
1.75
6.50
Tier Three
Benchmark
100
16
0.030
0.007
0.067
-
6.0 - 9.0
-
Notes:
Italics indicate results abave/oubside benchmark range.
' - See General Permit for description of Status (Tier One, Tier Two, etc.)

APPENDIX 1
Submittal to North Carolina Department of Environmental Quality

su

APPENDIX 2
Forms and Data to Be Included in Annex F of the Jacobsen Facility One Plan

Ran: OWC, KO
To: Samnth Dawson
cc: missinoer(Otextron_Wm
Subject: FW: Jacobsen Stnmmater NCG 030306
Date: Monday, February 22, 2016 10:14:14 AM
Attachments: Emaoe001.nnn
Hi Samanth,
Please see my confirming and clarifying comments inserted in your note below.
Ken
Ken Pickle
Stormwater Program Specialist
DEMLR Stormwater Permitting Program
Department of Environmental Quality
919 807 6376 office
ken.pickleCla ncdenr.aov
1612 Mail Service Center, Raleigh, NC 27699-1612
512 N. Salisbury St, Raleigh, NC 27604
Nothing Compares---,
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Samanth Dawson[mailto:[e-mail]]
Sent: Friday, February 19, 2016 5:26 PM
To: Pickle, Ken <[e-mail]>
Cc: Wissinger, Chris (Jacobsen) <[e-mail]>
Subject: Jacobsen Stormwater NCG 030306
Hi Ken
Thank you for taking the time to talk to me today regarding Jacobsen's stormwater situation. I feel
that our conversation was fruitful and beneficial for guidance from NCDEQ on the next steps with
the stormwater monitoring program at the Jacobsen facility.
Per our conversation earlier this afternoon, I am following up with this email to confirm the Plan of
Action for the Jacobsen facility in Charlotte NC. As we had discussed, Jacobsen will collect
Stormwater samples for Outfall 001 at their facility and analyze the samples for all parameters as
required by their General Stormwater Permit (NCG030000). The stormwater samples will be
collected on a monthly basis (nVar-ated by at least 30 days since the last sampling event (At the
moment my interpretation of the circumstances is that Jacobsen is subject to requirements in both
Tier 2 and Tier 3. The text of the permit provides that a permittee in monthly sampling does not
have to observe a full 60 days between sampling events, but the permit doesn't specifically

establish 30 days. See Part 11 page 5 of 10, bottom paragraph. Some separation between events
makes sense of course, but the text of the permit is not specific on this point. The objective should
be to obtain a sample in each calendar month. I think your task will be easier if you are not
constrained to waiting for a full 30 days between monthly events.) for three (3) consecutive
months, depending on occurrence of precipitation events, intensity (i_e- enough volume for an
actual discharge from the pond outfall pipe) and normal facility operating hours (the facility does
not operate on weekends).
In this regard and in order to collect monthly samples, we would like to confirm if the 72-ho>ar
mile for a measurable storm event Can be�siv� The 72 hour rule would come into play if
precipitation occurs on a weekend and the non -availability of facility staff to check on whether
there was an actual discharge from Outfall 001. (7 would like to hold to the 72-hour requirement
in the permit text. I realize this could result in us missing a month or months, with the result that
the completion of your Plan of Action would be delayed. But presumably it would not result in
extra sampling costs, since you would not be sampling non -qualifying events, anyway.)
Once the results from the three sampling events are available, Jacobsen will review, tabulate and
discuss the sampling results and submit it to your attention. Our understanding is that NCDEQ will
consider these results along with the historical ctormwoter sampling snabmes, quantitative
extent (i.e. -jinW) of the metals benchmark exceedances, canitaLcasts emended by
Jacobsen in source control and other factors in determining the release of the facility from monthly
monitoring requirements and reversion back to semi-annual monitoring for the remainder of the
General Permit term. (Yes, as we discussed. Also as we discussed, there are additional related
reasons for us to be receptive to the argument presented. The argument presented in Mr.
Wissinger's January 21, 2016 letter was very good and on point, and I fully expect this extra
analytical work will provide the little bit of extra support for that argument. As l relayed to you,
and as provided for in the permit text, we frequently review and approve requests to be relieved
from monthly sampling based on elements similar to those present in Jacobsen's circumstances.)
Please let me know if you have any questions or comments in the Plan of Action described above
or if we have misunderstood some of the items of discussion. Thanks for your all your help.
5amanth
SAMANTH E DAWSON, PE I PROJECT MANAGER
FISS ENVIRONMENTAL SOLUTIONS INC.
704-374-5393 (w) 1 704-215-4905 (f)
7252 Pineville -Matthews Rd, Suite 300
Charlotte, NC 28226

TIER ONEITWO/THREE STORMWATER RESPONSE
DOCUMENTATION RECORD
Directions: Complete this form in entirety if an analytical benchmark is exceeded.
Records: The general stormwater permit requires that this form be maintained in the
facility's SWP3.
I. Compliance Dates Date
a. Samples collected 02/23/16
b. Sample results received 03/10/16
c. Tier stormwater management inspection due
(must be within 2 weeks of date above) 03/24/16
d. Tier stormwater management inspection
conducted
e. Implementation of selected actions deadline
(must be within 2 months of date "d" above)
11. Data
Current
Previous 1*
Previous 2*
Outfail No.
Parameter
Benchmark
Analytical
Results
Results
ValuelUnits
Result
Date:10/28/15
Date:03/27115
Value/Units
Total Copper
0.007 m
0.0039 m
0.0098 m
0.0081 m
SW001
Total Zinc
0.067 m
0.082 m
0.044 m
0.068 mg/I
• If Previous I result was also exceeded, then implement Tier Two monthly monitoring. Continue until current, Previous 1 and
Previous 2 results are all under the benchmark. If during permit term, analytical results indicate benchmark exceedance for any
specific parameter at any specific outfall four (4) times, the outfall is considered to be in Tier 3 and written notice should be sent to
the DWQ Regional Supervisor within 30 days of the fourth sampling result.
III. Inspection Results
Conduct an inspection of the drainage area to the outfall and record the date in "d" above. Person(s) conducting inspection
a. Identification of possible causes of exceedance
b. Identification of possible controWimprovements (identify at least one)
© Source Control
❑ Operational Controls.
❑ Physical Improvements
© Other _--
IV. Implementation Record
Describe the actions completed to address the exceedance. If exceedance reoccurs in the next sampling, Tier Two actions are
mandated.
V. Maintain this form in the SWP3 per general Stormwater permit requirements.

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO30OW
Date submitted
CERTIFICATE OF COVERAGE No. NCGO30306
FACILITY NAME Jacobsen A Textron Company
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES: Tyler Rushin
LABORATORY: Shealy Environmental Inc. Lab Cert. p 329
Comments on sample collection or analysis;
Part A. Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD ❑ Ian -June ❑ luly-Dec
or ® Monthly' February _ 1monthl
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
® o-fiow ❑Water Supply ❑SA
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
n No discharve this nenod?z
No.
Date Sample
Collected'
(mo/dd/yr)
24hour rainfall
amount,
inches,
Tote! spended Solids
Su
�per
Standard units
Li
Zinc
Zi
Non -Polar OB,G/
Total Petroleum
Total
Hydrocarbons
Total ToxicQutfaO
Organics
Senchmorks =a
_
-
2W mg/L or SO rag/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 WL
IS mg/L
1 mg/L
WWI
iW23/16
1.75
li MR&
6S su
OAD38 oWL
<OA01 mg/L
0.08Z L
c5.6 mg/L
-
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
3 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 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.
5 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: 11/112012-10/3112017 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.'
CHRIS WMSINGER
Name (Print name(
FACAUTIES MANAGER
Title iPKint title)
(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,'< X mg jL where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L
Note. ff you report a sample value In excess of the benchmark you must implement Tier 1, Tkr 2, or Tler 3 responses. See General Permit tent
Part B; Vehicle Maintenance Area Monitoring Resutts: oniy for fadiities averaging > 55 gal of new oil per month.
FI No dischorae this period??
Outfall No
Date Sample
Collected'
(rno/dd/yr)
24arour rabrfatl
amount,
Indies
Non -polar o&G/TPH by
EPA 1654 (SGT-HEM)
Total Suspended Solids
pH
Bendrmarb >
_
-
15 mg/L
loo mg/L or So nq/L•
6.0— 9.0 SU
NA
NA
NA
NA
NA
NA
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. 11/l/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2of3

Nate: If you report a sample value in excess of the benchmark you must implement Tier I, Tier Z or Tier 3 responses. See General Permit tart
FOR PART AND PART B MONITORING RESULTS:
• A BENCHMARK FXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART Il 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 OLITFALL? YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT NAME: Marcia Allocco — Mooresville Regional Office & Ken Pickle — Central office
Mail an original and one cow of this OMIL includine all 'No Discharve"reports, wf Nn 30 dcw of recelat of the lab resuhs for at end of monftor(M perilad
in the case of '"No Disdrame" 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 property 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.
am aware that there are si scant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
. %M0
(Signature of Permittee) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

STORM EVENT DATA RECORD
Name of Facility: Jacobsen
Location: Outfall SWOOI
No. of Outfalls or Sample Locations = l
Instructions: Fill in ALL blank boxes and lines
Time interval
Actual Time
Rain Gauge -
(minutesr
�. Min_)
Record (inofa
0-
0
Storm Begins
3 ` �'� AM
-
a3o
Samples Collected
) � S
. Storm End eaa�:
1 1�r7
,
!, 7 a
Date 2--
No. of hours since previous measurable rain (O. l inches) 'j a hrs.
pH of samples: Record pH of the outf dl:
Sam le ` H , - Rain Crg ' e` H
E-- (2 -�D . (0 .9,
Samples collected by t-1" J 1 �'►1
Rain gauge reading taken by -`- l 70
pH meter read by: / -S " .')
is Outfall Visual Monitoring Record attached for the outfall?
NOTES:
(1) Time zero (0) means the beginning of storm or as soon as discharge from sample point
becomes visible.
(2) The rain gauge level and time must be reeorded at the end of the storm event

A�
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form please visit: .nc a r.or we d s w#ta -4
Permit No.: 1jg-j3j3j9j Q/"_ f or Certificate of Coverage No.: N-X1fi1ff13J���-k-1
Facility Name: JgLob ern. A 'cxti-ofi Como_ any
County: M
Inspector:
Date of In:
Time of In
Total Event Precipitation (inches): _' 7
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
even t" or 'measureable storm event"(requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm evenC is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 incites has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this rep is accurate and complete to the best of my knowledge:
(Signature of Permittee or
Page 1 of 2
SWU-242, Last modified 10/25/2012

L Outfall Description:
autfall No. M01 Structure (pipe, ditch, etc.) Lipe
Receiving Stream: Unnamed IlibUtM to 5peelc Creek
Describe the industrial activities that occur within the outfall drainage area:
mainteLent Manufactud!Ig
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: rL-4a k—
3. Odor: Describe any distinct odprs that the discharge may have (Le_, smells strongly of oil,
weak chlorine odor, etc.): M 0 _0 D D P" _
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 2 3 4 5
S. 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:
0
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:
�(1 ) 2 3 4 S
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No~
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe _
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, LWA modified 10/25/2022

PAGE NO.
DAILY RAINFALL RECORD
morfm VRAR�
DATE
TIME
RAINFALL (JNCM
ACEASURED BY
2-
3
4
5
6
7
F [In
.9
io.
ffv
12
43-
14
-16.
17
is
19
21
22
23'
77 S
-7
A r 1 2 4 ?7 q
2 4
24
2
25
2 26
6
27,
29
29
0
NOTE: Read ughly.theso time gangs aft= rcndm& unkm suwmw2ler es we
cvci)t Wait tiU storm is over and m reading fra rotative being CDII=Mdi cam page
- 7

Khan, Zahid
From: Khan, Zahid
Sent: Wednesday, February 03, 2016 3:25 PM
To: Pickle, Ken
Cc: Bennett, Bradley
Subject: RE: NCG030306 Jacobsen in Charlotte
Ken,
Thanks for doing that and I agree with your proposal. Please let me know if you need any inspection from us. Thanks
again.
From: Pickle, Ken
Sent: Wednesday, February 03, 2016 3:15 PM
To: Khan, Zahid <[e-mail]>
Cc: Bennett, Bradley <[e-mail]>
Subject: NCG030306 Jacobsen in Charlotte
Hi Zahid,
These folks make commercial grade turf maintenance equipment like riding lawn mowers for golf courses. They are
located at 11524 Wilmar Blvd. in Charlotte, in the Westinghouse Boulevard area. They discharge to an unnamed
tributary to Steele Creek, Class C. We have a request from this permittee to grant relief from monthly
monitoring. They entered Tier 2 in 2014, and are now in Tier 3 for copper, having accumulated 4 exceedances since
2013.
The physical circumstances are pretty clear, I think. Rather than forward to MRO for a site visit and for you to follow up,
I propose to contact the company directly and discuss with their environmental manager over the phone. Unless there
is a surprise in the phone call, I am going to release them from monthly monitoring based on three more monthly
samples that support their request. It is possible that 1 will hear something in the phone call that would prompt me to
involve MRO, but I want to avoid that if possible. I know your staff are stretched, too.
Would you want us to approach this differently? Do you have a recent history with this site? I don't see anything in the
files up here, or in RIMS. An inspection in 2013 by Mecklenburg County did not identify any stormwater issues.
Let me know if you want us to handle this differently than I have proposed.
Thanks,
Ken
Ken Pickle
Stormwater Program Specialist
DEMLR Stormwater Permitting Program
Department of Environmental Quality
919 807 6376 office
ken. [e-mail]
1612 Mail Service Center, Raleigh, NC 27699-1612
512 N. Salisbury St, Raleigh, NC 27604

January 21 st, 2016
RFCE1��D
JAMlS2016
"d Q,,OENIlity s
MooreSbille Region ction
al ice
Division of Energy, Mineral and Land Resources
Stormwater Permitting Section
ATTENTION: Bradley Bennet
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Re: General Stormwater Permit NCG 030000
Certificate of Coverage No: NCG 030306
Dear Mr. Bennet
aACC?BS-/V`
A Textron Company
11524 Wilmar Blvd.
Charlotte NC 28273
704-587-5934
Jacobsen, a Textron Company (Jacobsen) is currently covered under the General Stormwater Permit No.
NCG030000 for stormwater discharges from the facility associated with industrial activities. The drainage
features at the facility are engineered such that all stormwater runoff from the outdoor areas of the facility are
routed through a stormwater detention pond for treatment prior to off -site discharge through the pond outfall
(S W001). As part of the permit requirements, Jacobsen has been conducting visual and analytical stormwater
monitoring for Outfall SW001 on a semi-annual basis. However, due to benchmark exceedance of Total
Copper in the facility stormwater discharge, Jacobsen is currently in Tier 3 status according to the General
Permit regulations.
A historical summary of the facility stormwater analytical monitoring results are presented in Table 1 below.
Monthly monitoring for outfall SW001 was instituted and conducted (depending on occurrence of
precipitation events) upon two (2) consecutive benchmark exceedances for Total Copper. As can be observed,
the Total Copper and Zinc exceedances were very slightly above the extremely low benchmark levels (Total
Copper and Zinc at 7 ug/L and 67 ug/L, respectively) prescribed in the General Permit, thereby triggering the
tiered status for the facility stormwater discharge. While we feel that the November 2014 results were not
representative of the facility stormwater discharge, the metals exceedances from the other sampling events
were above benchmark levels by an average of 1.9 ug/l for Total Copper and an average of 4.5 ug/L for Total
Zinc.
The facility had been conducting stormwater inspections to determine the cause of the benchmark exceedance
for Total Copper and Zinc in the stormwater discharge since the first such exceedance in April 2013 and has
Jacobsen Stormwater Page 1 of 4 January 19, 2016

reviewed its outdoor storage policies and conducted root cause investigations for the metals exceedances as
part of its tiered inspections. The potential cause of the exceedances was narrowed down to potential
condensation of chemicals from the production paint exhaust vents on the manufacturing building roof and/or
(due to the very low metals benchmarks) from just normal precipitation in contact with the galvanized roofing
of the production/manufacturing/ warehouse building.
While replacing the entire facility with non -galvanized roofing would have been significantly cost prohibitive,
Jacobsen hired consultants and vendors to design and install filters/mist eliminators as structural controls on
the paint line exhausts to minimize the potential for condensation of paint/chemicals on the production
building roof which could possibly lead to metals stripping from the galvanized roofing, and thereby to
stormwater runoff during precipitation events.
Exhaust vent sampling for particulate emissions (PM) were conducted before and after the structural controls
(filters/mist eliminators) were installed and are presented in Table 2 below. Please note that these filters were
installed at significant capital costs totaling approximately eighty thousand dollars ($80,000) and were
operational as of December 2015. As can be observed, the results of the exhaust emissions sampling indicate
that the structural controls instituted have been successful in controlling the PM emissions and therefore
should be successful in reduction of Copper and Zinc in the facility stormwater runoff.
As such, we feel that Jacobsen has spent considerable resources in trying to meet the extremely low
benchmarks for Total Copper and Zinc in our General Permit. Therefore, we are respectfully requesting that
the facility be removed from the tiered status and the monthly monitoring stipulations of the General Permit
and be allowed to revert back to semi-annual stormwater monitoring for the remainder of the permit term.
Jacobsen is committed and dedicated to pollution control in all areas of production and we appreciate your
review and favorable response to our request. If you have any questions or we may be of further assistance in
this matter, please contact me at [phone].
Sincerely,
Jacobsen, A Textron Company
W/
Chris Wissinger
Facility/F.nvironmental Manager
cc: Marcia Allocco, NCDEQ Mooresville Regional office
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Jacobsen Stormwater Page 2 of 4 January 19, 2016

TABLE I
HISTORICAL SUMMARY OF STORMWATER ANALYSIS
OUTFALL SW001- JACOBSEN
Sample Date
Parameter
Outfall
Status'
TSS (mg/1)
Non -Polar
O&G (mgll)
Total Lead
(mg/1)
Total Copper
(mg/1)
Total Zinc
(mg/1)
Total Rainfall
(In.)
pH (s u)
04/04/13
28 1
<5.9
<0.010
0.0065
0.075
1.0
6.76
Tier One
11/01/13
6.2
<4.7
<0.010
0.0067
0.065
1.0
9.1
Tier One
04/07/14
8.7
<5.0
0.0013
0.0089
0.060
2.25
7.8
Tier One
11/17/14
160
1 <4.8
0.0056
0.040
0.270
2.25
7.83
Tier Two
01/12/15
12
<4.8
<0.001
0.0045
0.031
1.00
8.9
Tier TWO
03/27/15
1 12
<6.3
0.0012
0.0081
0.068
0.75
6.4
Tier Two
10/28/15
5.5
<5.3
1 0.002
1 0.0098
0.044
2.50
6.01
Tier Three
Benchmark
100
15
0.030
1 0.007
1 0.067
---
6.0 - 9.0
--
Jacobsen Stortnwater January 19, 2016

TABLE 2
SUMMARY OF MIST ELIMINATORIFILTER SAMPLING ANALYSIS
JACOBSEN
Location
PM Results (ppm)
Comment
06/26/15
12/08/15
Main Spray Booth
Exhaust
320
<10
• Uncontrolled samples collected -
on June 25, 2015 (i.e. before
installation of mist eliminators).
Reel Spray Booth
Exhaust
<10
<10
• Controlled samples collected on
December 8, 2015 (i.e. after
installation of mist eliminators).
* PM — Particulate Matter
Jacobsen Stormwater January 19, 2016

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted
CERTIFICATE OF COVERAGE No. NCGO30306 SAMPLE COLLECTION YEAR 2016
FACILITY NAME Jacobsen A Textron Company SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
COUNTY Mecklenburg or ® Monthly' February month
PERSON COLLECTING SAMPLES: Tyler Rushin DISCHARGING TO CLASS ❑ORW ❑HQW [-]Trout ❑PNA
LABORATORY: Shealy Environmental Inc. Lab Cert. 0 329 ❑Zero -flow ❑Water Supply [:]SA
Comments on sample collection or analysis: ®ref C
None
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
Part A: Stormwater Benchmarks and Monitoring Results
n No discharge this oeriode
outfall No.Collected
pate Sample
r
(mo/dd/yr)
24-iwur rainfall
des'
Total Suspended Solids
PH,
pH,
ft ward units
Copper
"d
Zinc
O&G/
Totallrocar Pertiroleu
Hyd
Total Tmic
Organics'
8enchnwr" —>
_
-
10D mg/L or 50 nWO
&0-9.0
0.W7 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
sw001
02/23/16
1.75
11 mg/L
6.5 Su
0.0038 mg/L
c0.WIL nWL
0.092 mg/L
<5.6 mg/L
-
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here_
3The 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: 11/1/2012-1D/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the 5tormwater 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 tonic 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."
CHRIS WISSINVGBR _
Name (Print name)
f} gIMESMANAGER
TdIe(P ttitle)
(Signature) (Date)
Note_ Results must be reported in numerical format. Do not report Below Detection Limit, BDL, cPQI, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format 'c= m V where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L
Note. If you report a sample value In extras of the bendrmart you must Implement Tier 2, Tier A or Tier 3 responses See General Permit text.
Part e: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No dischorge this period?'
Oul#a0 No.
[rate Sample
Copected'
(mo/dd/yr)
2"ow rainfall
amount,
Inches'
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks --=
_
-
15 mg/L
Oil mg/L or So mg/L*
6.0 — 9.0 SU
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017 SWU-245, last revised 10/2S/2012
Page 2 of 3

Note: If you report a sample value in excess of the benchmark you must implement Tler I, Tler 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 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS_ SEE PERMIT PART 11 SECTION e.
+ 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: Marda Alloao — Mooresville Regional Office & Ken Pickle — Central office
Mall an orfgfWl and one go, of this DM t fndudirm all ' W Discharge reports within 30 don o f receipt of the lab results for at and of g i orfna egfiow
in the case of "No Dlscharae" repartsl to:
Division of water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFIOATION FOR ANY INFORMATION REPORT_E_D.-
"1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system deslgr a 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.
am aware that there are Significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.'
(Signa ure of Pe itteel (pate)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

FILE COPY
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quay General Permit No. NC6030000
Date submitted ?r ' ! 1f
CERTIFICATE OF COVERAGE NO. NCGO30306 SAMPLE COLLECTION YEAR _ 2015
FACILITY NAME Jacobsen, A Textron Company _ SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
COUNTY Mecklenburg or ® ManthW Octobermonth
PERSON COLLECTING SAMPLES: YYo'anis Domingue RECEIVED DISCHARGING TO CLASS ❑ORw ❑HQW ❑Trout ❑PNA
LABORATORY: Shealy Environmental Inc. Lab Cem # 329 n r v Q 2415 ❑❑ Zero -flow Water Supply ❑SA
Comments on sample collection or analysis: ®Other C
None L FILES
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4DWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
M No disrharae rhic nvrind72
No
Date Sample
fallerted i
(mo/dd/yr)
244rour rainiall
amount,
Indres3
Total Suspended Solidi
pH,
Standard units
Copper
Lead
Zinc
Non -Polar �/
Total Petroleum
Hydrocarbons
Total ToxicOutfall
Organics s
Searhme►16
-
-
1W nWL or 50 mg/L
6.0 — 9.0
(LOOT mg/L
OA3 mg/L
0.067 mg/L
15 mg/L
1 mg/L
5W001
10/29/15
2.5
5.5 mg/L
GOi su
MM mg/L
M002 L
M044 mg/L
c53 L
—
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites maybe eligible for a waiver of the rain gauge requirement.
` 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 Organic, 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:11/112012-10/31/2017
SWU-245, last revised 10/2.5/2012
Page 1 of 3
I

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."
CHRIS WLSSINGER _
Name (Print name)
FACIUTIES MANAGER
Title (Print ' le)
(Signature) (pate)
Note: Results must be reported in numerical format Do not report Below Detection limit, SDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format. '00f WLV. where XX is the numerical value of the detection
limit, reporting limit, etc in mg/L
!Yore. if you report a sample value In excess of the benchmark you must implement Tier 1, Tier2, or Tier 3 responsim See General Permit text
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No dischore this period;"
outfall No.
Date Sample
Collected 1
(mo/dd/ )
24-hour rahtfall
amount
Inches'
Non -polar p&Gf"%by
EPA 1664 (SGT-HEM)
Totaf Suspended Sol7ds
pH
Bendiniarl6 = a
_
-
15 mg/L
Wo mg/L or 50 mdo
6A — 9.0 Sri
NA
NA
NA
NA
NA
NA
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:11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note- 1f you report a sample wWue in excess of dw benrhmarir, you must bnphwwnt Tier 1, Tier 2, or Tier 3 responses. See Genem! Permit text.
FOR PART A AND PART B MONITORING RESULTS_
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART [I 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 OUTFALL7 YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO ❑
REGIONAL OFFICE CONTACT NAME: Marcia iAllocm — Mooresville Regional office _ _ _-
Mail an aftrial and one ODOY of this AMA, Inaludin�all "TYa Disdlarg�parts, within 30 days of reedot owe lab results for at end of monllorina period
in the case of -No Digiarae' rleaarisl ta: - —
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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Z , I' L
(Signature of Permittee) (Date)
Permit Date: II/1/2012-10/31/2017 SWU-24S, last revised 10/25/2012
Page 3 of 3

hc6L-o 3o3a� 2016�
Forms and Data to Be Included in Annex F of the Jacobsen Facility One Plan

46

TIER ONE/TWO/THREE STORMWATER RESPONSE
DOCUMENTATION RECORD
Directions: Complete this form in entirety if an analytical benchmark is exceeded.
Records: The general stormwater permit requires that this form be maintained in the
facility's SWP3.
1. Compliance Dates
a. Samples collected
b. Sample results received
c. Tier stormwater management inspection due
(must be within 2 weeks of date above)
d. Tier stormwater management inspection
conducted
e. Implementation of selected actions deadline
(must be within 2 months of date "d" above)
II. Data
Date
10/28/15
11/25/15
12/07/15
Current
Previous I*
Previous 2*
Outfall No.
Parameter
Benchmark
Analytical
Results
Results
Value[Units
Result
Date:03/27115
Date:01/12/15
Valuefunits
TSS
100Mgt]
5.5m
12 mgA
12m
SW001
Total Copper
0.007 m
0.0098 m
0.0081 m
0.0045 m
Total Zinc
0.067 m
0.044 m
0.068 m
0.031 mg/1
* If Previous I result was also exceeded, then implement Tier Two monthly monitoring. Continue until current, Previous I and
Previous 2 results are all under the benchmark. If during permit term, analytical results indicate benchmark exceedance for any
specific parameter at any specific outfall four (4) times, the outfall is considered to be in Tier 3 and written notice should be sent to
the DWQ Regional Supervisor within 30 days of the fourth sampling result.
III. Inspection Results
Conduct an inspection of the drainage area to the outfall and record the date in "d" above. Person(s) conducting inspection
a_ Identification of possible causes of exceedance
b. Identification of possible controls/improvements (identify at least one)
❑ Source Control
0 Operational Controls
© Physical Improvements
© Other
IV. Implementation Record
Describe the actions completed to address the exceedance. If exceedance reoccurs in the next sampling, Tier Two actions are
mandated.
V. Maintain this form in the SWP3 per general Stormwater permit requirements.

Semi-annual Stormwater Discharrue Monitorina Resort
for North Carolina Division of Water Quality General Permit No. NCGO30OW
Date submitted _ 2 , i _ j I
CERTIFICATE OF COVERAGE No. NCGO30306 SAMPLE COLLECTION YEAR 2015
FACILITY NAME Jacobsen, A Text n Corrivany SAMPLE PERIOD [] Jan -June ❑ Juty-Dec
COUNTY Mecklenburg or ® *1onthW-9qqkL-______LRon h
PERSON COLLECTING SAMPLES_ Yoh is Domingue _ _ DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY: Shealy Environmental Inc. Lab Cart 8 329 ❑Zero -flow []water supply ❑m
Comments on sample collection or analysis: ®Other . --� _ _ -
N e
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
Part A: Stormwater Benchmarks and Monitoring Results
n No disrhQroe this nprind72
Outfal! No.
Date Sample
C d ,
{coo/dd//dd/yr)
24haur rainfa0
amount.
lndhes'
Total Suspended So Bds
pR'
Standard units
Copper
Lead
zinc
Non -Polar 0"/
Total Petroleum
Flydrocarboru
Total Tmtk
organks
Berxhmofft
_
-
2W mg/L or 50 mg/L
6.0 - 9.0
0.007 mg/L
043 mg/L
0.067 rots%!.
15 mg/L
1 mg/L
9W001
W/29/15
2.5
5_S mg/L
6.01 su
*AM mg/L
U.002 L
0.044 L
<5.3 nwL
-
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outtall.
Z For sampling periods with no discharge at any single outfail, 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 he 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 Bound 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), 1 certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the storrnwater 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 Po[hrtion Prevention Plan."
C,HRJUS WISSINGER
Name (Print name)
FAC1LM S MANAGER
Title (Print title)
C:....A- i
(Signature) is (Date)
Mote: Results must be reported in numerical format. Do not E wrt_ 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 farrnat, `4= mdV where )O( 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 Z or Tier 3 responses. See Gene ml Permit text.
Part & Vehicle Maintenance Area Monitoring Results: only for facilities averaging a 55 gar of new oil per month.
{1 No discharge this period?'
Onrdall No.
Date Sample
CoDected'
(mo/dd/yr)
Z4atour rainfa0
amount.
Indies'
Non -polar Oi&G/TPH by
EPA 1654 J%-r-HEM)
TotalSuspendedSOS
P„
Bendunarks
15 mg/L
100 mg/L or 50 mg/L•
6.0 — 9.0 Sri
NA
NA
NA
NA
NA
NA
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: 11/112012-10/31/2017 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 Penult text
FOR PART AAND PART BMONITORING 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 li SECTION S.
• 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: Marcia Allocco — Mooresville Regional Office
Mail on w0,inal and one copy of this DMa Indueftaff No DWwrae' MM ts_within 30 days g JMWnt of the lab results !or at end of monftarkna period
in the case oNo Dlsrharze"' reaartsl 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 property 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.
am aware that there are significant7'-�m
�Itting false information, including the possibility of fines and imprisonment for knowing violations."
P I-- ki 9, s-7 - I -,IS
(Date)
Permit Date: li/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

STORM EVENT DATA RECORD
Name of Facility: Jacobsen
Location: Outfall SW001
No. of Outf dls or Sample Locations = 1 Date C L� 2 '!
Instructions: Fill in ALL blank boxes and lines
Time interval
Actual Time
Rain Gauge ..:-
(minutes)nl
)
Record (inch)
S s
0-30
Samples Collected
:5 ' • qO Yn
„
No. of hours since previous measurable rain (0.1 inches) -7L hrs.
pH of samples: Record pH of the outfall:
Sam leIWA G gepH`
V t0 1 �r
Samples collected by
Rain gauge reading - C -
pH meter read by-, -
Is Outfall Visual Monitoring Record attached for the outW19 '
NOTES:
(1) Time zm (0) means the beginning of storm or as soon as discharge from sample point
becomes visible.
(2) The ram gange level and time must be recorded at the end of the storm event.

L A
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out thisfa m, please visit. hap://Aorta.ncdenr.org/web _W Jwslsu/npdussw#tab-4
Permit No.: or Certificate of Coverage No.:
Facility Name: jacob.5gn. A TtKirollCompany
County: Mecklenburg Phone No. 704-587-5934
Inspector: `e
Date of Inspection: - a -T .-
Time of inspection: 5 'Lfo P—
�l
Total Event Precipitation (inches): :2 1 S
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Cl/Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a *representative storm
event" or measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
Page 1 of 2
SWi1-242. Last modified 10/25/2012

1. Outfall Description:
Outfall No. SM01 Structure (pipe, ditch, etc.) pe
Receiving Stream: Unnamed tributaryto Steele Creek
Describe the industrial activities that occur within the outfall drainage area:
mainteniince equipment manufactuilng
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor. Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and S is very cloudy:
U 2 3 4 5
S. 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:
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-
0 2 3 4 5
7. is there any foam in the stormwater discharge? Yes
8. is there an oil sheen in the stormwater discharge? Yes
9. is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
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 10/25/2012

PAGE -NO.
DAELY RAIIVFAILL RECORD
-MONTH YEAR - " - - - '
�i II.
I'
'
UWA vl

SHEALY ENVIRONMENTAL SERVICES, INC.
Report of Analysis
Jacobsen, Inc.
11524 Wilmar Blvd
Charlotte, NC 28241
Attention: Chris Wissinger
Project Name: Jacobsen Stormwater
Lot Number:QJ28088
Date Completed:1110612015
Kelly M. Nance
Project Manager
LABORATORY
ACCR€WAiION
IM4 (b,
BUREAU .i5:
ACCREDlTEDrsoar
This report shall not be reproduced, except in its entirety, without the written approval of Shealy Environmental Services, Inc.
The following non -paginated documents are considered part of this report: Chain of Custody Record and Sample Receipt Checklist.
Shyly Envftrimental Services, Inc. Page: 1 of 5
106 Vantage Point Drive V&St Columbia, SC 29172 [phone] Fax [phone] www.sheatylab.com

SHEALY ENVIRONMENTAL SERVICES, INC.
SC DHEC No: 32010 NELAC No: E87653 NC DENR No: 329 NC Field Parameters No: 5639
Case Narrative
Jacobsen, Inc.
Lot Number-: QJ28088
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary following this Case Narrative. The sample
receiving date is documented in the header information associated with each sample.
All results listed in this report relate only to the samples that are contained within this report.
Sample receipt, sample analysis, and data review have been performed in accordance with the most current approved NELAC standards, the
Shealy Environmental Services, Inc. ('Shealy"} Quality Assurance Management Plan (CAMP), standard operating procedures (SOPS), and Shealy
policies. Any exceptions to the NELAC standards, the CAMP, SOPS or policies are qualified on the results page or discussed below.
If you have any questions regarding this report please contact the Shealy Project Manager listed on the cover page_
Shealy Environmental Services, Inc. Page: 2 of 5
106 Vantage Point Drive Writ Columbia, SC 29172 [phone] Fax [phone] vrww.sheatylab.corn

SHEALY ENVIRONMENTAL SERVICES, INC.
Sample Summary
Jacobsen, Inc.
Lot Number: QJ28088
Sample dumber Sample ID Matrix Date Sampled Data Received
001 SM outfall 001 Aqueous 10127/2015 1600 10/28/2015
(1 sample)
Shealy Environmental Services, tnt. Page: 3 of 5
106 Vantage Point Drive West Columbia, SC 29172 (803) 791-97o0 Fax [phone] www.sheatylab.cpm

Inorganic non-metals
Client:Jacobsen, Inc. Laboratory ID:Q328088-001
Description: S1W outrall 001 Matrix: Aqueous
Date Sampled:1012712015 1600
Date Received:1012812015
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Data Batch
1 (TSS) SM 254OD-2011 1 10/30/2015 4858 DMA 88314
1 (SGT - HEM (n) 1684B 1 11/05/2015 1936 JDW 88882
CAS Analytical
Parameter Number Method Result Q POL Units Run
TSS �.. SM 254OD-20 5.5 1.0 mglL 1
SGT - HEM (non -polar material) 1664B ND 5.3 mg1L 1
POL = Practical quant Uftn limit 8 = Detected in fha method Wank E = 4uaravtaiiori or Compoxr d ex®edW the mlibrabon range H = Out of folding time
NO = Not detected at or above the POL J = Estimated result < PQL and � MIDL P = The RPD between two GC rnharcts exceeds 40% N = R ewvery is out 0 criteria
Where applicable, all sdl sample analysis am reported on a dry weigM basis unless flagged with a W
Shealy Environmental Services, Inc. Page: 4 of 5
106 Vantage Point Drive Wrest Columbia, SC 29172 [phone] Fax [phone] www.shealylah.com

ICP-MS
• ClientJacobsen, Inc. Laboratory ID:OJ28088-001
Description: SM Qutfall 001 Matrix: Aqueous
Date Sampled:101271201516M
Date Received:1012812015
Run Prop Method Analytical Method Dilution Analysis Date Analyst Prep Data Batch
1 200.2 200.8 1 11/05/2015 23D8 BNW 1012MO15 1312 88289
CAS
Analytical
Parameter
Number
Method
Result Q
PQL
Units
Run
Copper
7440-504
200.8
9.8
1.0
ug/L
1
Lead
7439-92-1
200.8
2.0
1.0
uglL
1
Zinc
7440.66-0
200.8
44
10
ug1L
1
PQL = Practical quan]itation limit 6 = Detected in the mallvd Warlr E = Quanblaticn of compound exceeded the calibration range H = Out of hWdit time
ND = Not detected at or above the PQL J - Estimaled result a PQL and > ME>L P = The RPD between hvo GC coltam mumeds 409E N = Recovery is out or criteria
Where applicable, all serf sample analysis are reported on a dry weight basis unless flagged with a W
Shealy Environmental Services, Inc, Page: 5 of 5
106 Vantage Point Drive Weat Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com

Chain of Custody
and
Miscellaneous Documents
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.sheelylab.com

tA

51
SHEALY ENVIRONMENTAL. SERVICES, INC.
Chain of Crrstad Record 10a Vantage Point brlve • West CclurrbW SC 29172
} Y Telephone No. S0a-791.9700 r-ax Na. 003.791.9111
�'v� • www.shoolab.com
Number 42893
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SHEALY ENVIRONMENTAL SERVICESt INC.
n�rClUflLtl �I1'EaIS",srMOU K"r—
Ft ets:�c 17a:r lU.^_lrl S
Sample Receipt Checklist (SRCQ
Q
CooleK h r =tc--d by.date-' : f g�►s Ilnt #71
-
Means of receipt SkS1 +] t:heal ❑ UPS ❑ FedU ❑ O;luz
Ycs 07 No i . Arcze ms!2dy scars a rnt on the cooler?
Yes D I No L-1 I m ❑ J 2. If;--modv seals were weal. ,v= the} inlact srsd uc►bru]ict�t":
pr1 strip ID: f Cl strip ILI:_ _
Cooler I kigit�rnrpezaltneurwm receil VDcrib (corrected) tP111pesat7ue upon reC6
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14o U
WA ff
4. 1s the commexedal courier'ss (rac;king slip at adwd to this form?
Yes
13a❑
1
5. Werr cuatndy praeeldwc_- {nlimquished''receitie� fiellnwcxl?
Ycs ❑
I Na ❑
NA Ej
Sa Were les: refinquiRbed bry client to comun=x.;al o=ie!
YPs
Na
b. Wcae t IN listed im theCOU!
Y:3
No ❑
?. Wt= sauTte IDs listed ou all sample cneltaime s?
Y�:s
1 Nn
S. Was collection date & lime listed on the CDC?
Y- 01
No D
1
9. Was collection elate &- time hstcd on ail sample conra:n s?
Yrs
No ❑
I
1 U. Did all cornuintr label information (I17, dair, rime) agrm with the C[X':
Yea
—Kn ❑
1
11. Wcr. (mis to be ptEftained listed on the C UC:?
Yes Fer
Nu El
I
i 112. Did all samples arrive in the proper coulaincn for each test?
Yes 0
Ve El
1
13. Dui all containers arrive in gad ccmdirion unbroken, lids eur, etc-)?
Ycs
No
14. Wits adequater le volume available'
YCS _1
e ❑
1s. Were aD sarrr:rlez 1rzn��ed within :i she holding time or 48 buurs, r'a ahiche
come9 first?
16. We" any sample cnttlaihQs mL%in ?
Y,
NoEF
Yes ❑
No.EF
1?, Wcrc there: any moms sanzlries not listed an COC?
Ycs ❑
No ❑
NA
l R. Were bubbles � >" _size " (,A"or 6tnm in diameter in any VOA tials?
es
i
19. Were all meta1&n&.fi4ffiM%autrinnl!!Mies recdved at u pH of e2'!
as ❑
1No ]
1dA
20. Ware: all c anide and%ar sulfidc smylas taived at u pH > 127
Yes ❑
Ko ❑
NA
21. Were all applicable NH3rT",*cyanide'phecjc}l (--0.2m&iL) samples fray of
residual chladne?
}•� ❑
�Iu ❑
NAK
22. Were colloolion tesnperutu= documrnicd an the COC for NC: samalaV
Ycq ❑
No ❑
IAA
2?. LYert diet n rye =k.: ircquects (ix, requested Outiam, MSr'1�D l otions,
etc, _ . Gorr[Gdy ttamtwibcd f -om the COC into Aw comment sL>�on ill I XMS?
Ycv
No
24. Was the quoit: tuber used taken frcmr the cuataimer htbd?
Sample rm4wrv%6an (Must he evaripleted for any sample(s) incorrectly prascr%,cd or with headspac e.)
sample(s) _ - ware recessed iwotructly prmavcd and wem reeljuareei
accordingl • in sample roucivingwith I- ;SOS, I Ilrl1.13 HCl, NaO u sing SR
were receivvd with brubbles = 6 mm in diameter.
Sa>xzFl s wQa received wilt TRC >0.2 !- [f #21 is Nn)
SC: LNjnk n& W%ateT Prujcrt Sample(&) pH vetlif:ed to be � 2 by., _` DOC:
Satin sy -a-ere not received at a pH of c'2 and wwa, wljLvdrd socaadid USWA 1qW
Sample labels lied by_ _ vtZilitA bV: _ Date:
Comm
Sheaty Environmental Seances, Inc,
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.sheaiylab,com

+ Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Per it No. NCG030000 I�
Date submitted ©c t ti ll ` -MT COD
CERTIFICATE OF COVERAGE NO. NCG030306
FACILITY NAME Jacobsen, A Textron Company
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES: NA
LABORATORY: NA Lab Cert. #NA_ _
Comments on sample collection or analysis:
None
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2015 --a
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec Wd9
or ® Monthly(__ May (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RECEIVED
[]Zero -flow [:]water Supply ❑SA
®Other C
OCT A 7 Z015 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
CENTRAL FILES
DWR SECTION
® No discharge this period?2
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
Organics
Benchmarks T==>
_
-
100 mg/L or 50 mg/L
6.0 -- 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
SWo01
NA
NA
NA
NA
NA
NA
NA
NA
--
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 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.
° See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 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 wAlved. 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."
CHRIS WISSINCER
Name (Print name)
FACILITIES MANAGER -
Title (Print title)
/0`�v�l�
(Signature) v (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 Tler 3 responses. See General Permit text
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > S5 gal of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inche?
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks
1S mg/L
100 mg/L or 5o mg/L*
6.0 — 9.0 SU
NA
NA
NA
NA
NA
NA
Footnotes from Part A also apply to this Part 6
" See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

- .
Note: If you eeport a sample value In excess of the benchmark, you must implement Tier 1, Tier 1, 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 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 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:
Moff an orWinaland one cogy of this DMR including all "No Dlsch " negorts. within 30 dayl of recel, t of the lab results for at end of monitarIng period
In the case of "No Discharae" 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 therq are significant penalties for submitting false Information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
0 ,' - I S
(date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

A Textron Company
1ij .1 41r 11211l038"E I l
October 6th, 2015
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of September 2015. Stormwater samples from a measurable storm
event were not collected this monthly period due to precipitation events occurring after business hours or on
weekends.
Sincerely,
Jacobsen, A Textron Company _
Cll -
Chris Wissinger
Facility/Environmental Manager
Attachments

Semi-annual Stormwater Discharge Monitoring Report .�
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG030306 SAMPLE COLLECTION YEAR 2015 COD
FACILITY NAME Jacobsen, A Textron Company SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
COUNTY Mecklenburg or ® Monthly)_ May_ _ _ (month)
PERSON COLLECTING SAMPLES: NA DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
LABORATORY: NA lab Cert. #NA ❑Zero -flow ❑Water Supply []SA
Comments on sample collection or analysis: RECEIVED ®Other C
None �.. -
SEP 0 4 2015 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
Part A: Stormwater Benchmarks and Monitoring Results CENTRAL FILES
DWR SECTION
® No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organice
Benchmarks =__>
-
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
SW001
NA
NA
NA
NA
NA
NA
NA
NA
--
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here,
3The 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.
a 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."
CHRIS WISSINGER
Name (Print name)
f}ICIL[UES MANAGI R
Title (Print title)
(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 reporteA in the format. "<XX ms/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.
El No discharge this period?2
Outfail No.
Date Sample
Collected"
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar 0&G/TPH by
EPA 1664 (5GT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017
5WU-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 PA?,j A AND PART B MO ITORI G RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART It SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION a.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ED
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mall, an original and one cony 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" Mpor s) 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 are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permittee?
Permit Date: 11/1/2012-10/31/2017
(Date)
SWU-245, last revised 10/25/2012
Page 3 of 3

JACE7BS=N'
A Textron Company
VIA CERTIFIED MAIL
September 2nd 2015
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of August 2015. Stormwater samples from a measurable storm event
were not collected this monthly period due to precipitation events occurring after business hours or on
weekends.
Sincerely,
Jacobsen, A Textron Company
Chris Wissinger
Facility/Environmental Manager
Attachments
31

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted �;- (o
CERTIFICATE OF COVERAGE NO. NCG030306
FACILITY NAME Jacobsen A Textron Company
COUNTY Mecklenburiz
PERSON COLLECTING SAMPLES: NA
LABORATORY: NA Lab Cert. #NA
Comments on sample collection or analysis:
None
Part A: Stormwater Benchmarks and Monitoring Results
RrCEIVED
AUG 1 0 2015
CENTRAL FILES
SAMPLE COLLECTION YEAR 2015 17WF2 SECTION
SAMPLE PERIOD ❑ Jan4une ❑ July -Dec
or ® Monthly' !month)
DISCHARGING TO CLASS ❑ORW ❑IiQW ❑Trout ❑PNA
❑Zero -flow []WaterSupply [:]SA
®Other C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
® No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar 0&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organics
Benchmarks ===>
_
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
SW001
NA
NA
NA
NA
NA
NA
NA
NA
--
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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

"FacilMes 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."
CHRIS WISSINGER
Name (Print name)
FACILITIES MANAGER
Title (Print title]
(Signature) U (Date)
Note: Results must be reported In numerical format. Do nod relaort 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 mgLL", 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.
❑ No discharge this period?z
OutfaH No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
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
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017 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 11 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 ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an griginal and one cony of this QMR Intl udlna all "No Dlscharae" reports, within 30 days of regeipt of the lab results (or at end of monitoring period
In the case o "No Discha e" re a to:
Division of Water Quality
Attn: DWQ Central Fifes
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"l 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 eva ate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering t nformation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. 1
am aware that there are significant penaltie r submitting false information, including the possibility of fines and imprisonment for knowing violations,"
"re of Permittee)
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

A 7P.xtMn Campa"Y
VIA CERTIFIED MAIL
August 6th, 2015
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of July 2015. Stormwater samples from a measurable storm event
were not collected this monthly period due to precipitation events occurring after business fours or on
weekends.
Sincerely,
Jacobsen, A� Textron Company
OL-
fJ/
Chris Wissing
Facility/Environmental Manager
Attachments

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted -7--6' fcr
CERTIFICATE OF COVERAGE NO. NCG030306
FACILITY NAME Jacobsen, A Textron Company
COUNTY MecklenburgRECEIVED
PERSON COLLECTING SAMPLES: NA
LABORATORY: NA Lab Cert. #NA JUL 15 2015
Comments on sample collection or analysis: CENTRAL FILES
None D R SECTION
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2015 >
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec J
or ® Monthly' May (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
®Other C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
® No discharge this period
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
Organicss
Benchmarks =-_>
_
-
100 rng/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
SW001
NA
NA
NA
NA
NA
NA
NA
NA
--
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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 469.31j.
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 5tormwater Pollution Prevention Plan."
CHRIS WISSINGER
Name (Print name)
FACILITIES N GE
Title (Print title)
7'8`i�'
(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 ma/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 Z 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.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G/TPH by
EPA 1664 (5GT-HEM)
Total Suspended Solids
pH
Benchmarks ===>
_
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 5U
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017 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 77er 3 responses. See General Permit text.
FOR PART AAND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER i 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 it 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:
Mail an original and one coov of this DMR includin all "No Dischar e" reports, within 30 days of receipt of the lab results or at end of monitoring eriod
In the case of "No Discharae" reoortsl 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 are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
re of Permitteej
i
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

9
� Q--?H MW
A TacOnn Company
VIA CERTIFIED MAIL
July 8th, 2015
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of June 2015. Stormwater samples from a measurable storm event
were not collected this monthly period due to precipitation events occurring after business hours or on
weekends.
Sincerely,
Jacobsen, A Textron Company
&A�C' �<'
Chris Wissinger
Facility/Environmental Manager
Attachments

M
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted (o - t-1 s
CERTIFICATE OF COVERAGE No. NCG030306
FACILITY NAME Jacobsen A Textron Company
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES: NA
LABORATORY: NA Lab Cert. #NA
Comments on sample collection or analysis:
None
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
or ® Monthly' May !month]
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA C-
❑Zero-flaw []Water Supply ❑SA
®Other C -110
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
® No discharge this period
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
Organicss
Benchmarks =__>
_
-
100 mg/L or 50 mg/L
6.0 - 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
MOM
NA
NA
NA
NA
NA
NA
NA
NA
--
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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.
° 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 5WU-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
-,nay 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."
CHRIS WISSINGER
Name (Print name)
FACILITIES MANAGED„
Title (Print title)
-d,zz ���
(Signature) (Date)
Note: Results must be reported In numerical format. Don t 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 reeRorted in the format. "<XX ma/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 firer 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.
❑ No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar 0&G/TPH by
EPA 1664 (5GT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
-
-
15 mg/L
100 mg/L or 50 mg/L*
6.0 — 9.0 SU
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017 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 Tler 1, Tier 2, or firer 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER k 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:
Mall an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results i'or at end of monitoring period
in the caseof "No Discharge" [Worts) o:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFIgAT-ION FOR ANY INFORM TIO 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 are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permittee)
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

ACE — .6�%�
A TMeDw Company
VIA CERTIFIED MAIL
June 8th, 2015
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of May 2015. Stormwater samples from a measurable storm event
were not collected this monthly period due to precipitation events occurring after business hours or on
weekends.
Sincerely,
Jacobsen, A Textron Company
Chris Wissinger
Facility/Environmental Manager
Attachments
gZ
z

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted S' 07-nr
CERTIFICATE OF COVERAGE NO. NCG030306 ,
FACILITY NAME Jacobsen A Textron Company
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES: NA
LABORATORY: NA Lab Cert. #NA
Comments on sample collection or analysis:
None
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
or ® Monthly April (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
[]Zero -flow ❑Water supply [:]SA
®Other C
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
No discharge this period?2
Outfall No.
Date Sample
Collected'
(mp/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organicss
Benchmarks =__>
_
-
100 mg/L or 50 mg/L
6.0 - 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
MOM
NA
NA
NA
NA
NA
NA
NA
NA
--
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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.
See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 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 5WU-245, last revised 10/25/2012
Pagel of 3
-U

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."
CHRIS WISSINGER
Name (Print name)
FACILITIES MANAGER
Title (Print title)
S-DrP-t,r
( ignaturej (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 mg/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 Z 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.
❑ No discharge this period?'
Outfall No.
date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
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
NA
NA
NA
NA
NA
NA
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-.11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

r
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
4 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:
Mail an orlainol and one copy of thls DMR. lncludina ail "No Discharae" reports within 30 days of receipt of the lab results for at end of monitoring perlod
In the case of 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 property 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."
a -
of Perrnittee)
J ' 0 7
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

as A CQ�S n%
A Tbrp n Company
VIA CERTIFIED MAIL
May 07, 2015
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
RECEIVED
MAY 07 K115
CENTRAL FILES
DWR SECTIC"!
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of April 2015. Stormwater samples from a measurable storm event
were not collected this monthly period due to precipitation events occurring after business hours or on
weekends.
Sincerely,
Jacobsen, A Textron Compan
Chris Wissinger
Facility/Environmental Manager
Attachments

A Semi-annual Stormwater Discharge Monitoring Report
r' for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted &-!- / 7 - /J--
CERTIFICATE OF COVERAGE NO. NCG030306
FACILITY NAME Jacobsen, A Textron Company
COUNTY Mecklenburp, _
PERSON COLLECTING SAMPLES: Tyler Rushin
LABORATORY: Shealy Environmental Inc. Lab Cert. # 329
Comments on sample collection or analysis:
None
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
or ®Monthly' March - (month)
RECEIV RGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
[]zero -flow []waterSupply ❑SA
APR 2 0 2015 ®other C
CENTPAL FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
DWR SECTION
No discharge this period?'
__7
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Sollds
pH,
Standard units
Copper
Lead
Zinc
Non -Polar 0&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organics
Benchmarks
100 mg/L or 50 mg/L
6.0 - 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
SWo01
03/27/15
0.75
12 mg/L
6.4 su
0.0081 mg/L
0.0012 mg/L
0.068 mg/L
<6.3 mg/L
--
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 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.
5 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 5WU-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
r 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."
CHRIS WISSINGER
Name (Print name)
FACILITIES MANAGER
Title (Print title)
(Sirature) /G-, (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 mix/C 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.
No discharge this period?z
Outfall No.
date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches
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
NA
NA
NA
NA
NA
NA
Footnotes from Part A also apply to this Part 8
* See General Permit text, Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

r'
Note: if you report a sample value in excess of the benchmark, you must implement Tier I, Tier 1, 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 ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an orlainal and one copy of this DMIi, Includina 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 are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date: 11/1/2012-10/31/2017
"-1 -/ -7-ij
(Date)
SWU-245, last revised 10/25/2012
Page 3 of 3

Semi, -annual Stormwater Discharge Monitoring -Report
for North Carolina Division of Water Quality General Permit No. NCG030000
CERTIFICATE OF COVERAGE NO. NCG030306
FACILITY NAME Jacobsen. A Te cZtron Comvanv -
COUNTY Mecklen ur
PERSON COLLECTING SAMPLES: NA
LABORATORY: NA Lab Cert. #NA
Co ments on corn le collection or anal sic•
Date submitted
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
RECEI� 1 or ® Monthly' February 1m_onth)
V 1 V E CHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
MAR Q 9 2015 ❑Zero -flow ❑Water Supply ❑SA
m P y tZOther_ C
None CE'NTRAL. FILES
D\NR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
No discharge this perrad?Z
Outfall No.
Date Sample
Collected'
(mo/dd/ r)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
pHj
Standard units
Copper
Lead
Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organicsg
Benchmarks
100•mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0,03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
$Wool
NA
NA
NA
NA
NA
NA
NA
NA
--
' Monthly sampling (Instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'For sampling periods with no discharge at any single outfall, 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.
a 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/l/2012-10/31/2017 5WU-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 TFQ 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
(TT0), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwateror areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certifythat this facility 1s Implementing the all the provisions of the
solvent management plan Included in the Stormwater Pollution Prevention Plan."
CHRIS lE
Name (Print name)
1FACILITIES MANAGER
Title (Print title)
ak�_" ��� s- z -l
(Signature) (Date)
Note: Results must be reported In numerical format. Do not resort Below Detection Limit, BDL, <Pql., Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, then must be reported in the format. "<XX mg/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 gall of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
mo/dd/yr)
24-hour rainfall
amount,
Inches'
Nan -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
NA
NA
NA
NA
NA
NA
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:11/1/2012-10/31/2017 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 PARTA AND PART B MONITORING RE5ULT5:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 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:
Mall an original and one cony. of this DMR, including all "No Discharge" reports. within 30 days of receipt of the lab results (or at end of monitoring aerfod
1n 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 forgathering 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 Permittee)
3` Z^ f J
jDate)
Permit Date; 11/1/2012-10/31/2017 SWU-245, ilast revised 10/25/2012
Page 3 of 3

J/�C�BS-N
A Textron Company
VIA CERTIFIED MAIL.
March 3, 2015
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall (SDO)
Monitoring Report form for the Month of February 2015. Stormwater samples from a measurable storm event
were not collected this monthly period due to precipitation events occurring after business hours or on
weekends.
Sincerely,
Jacobsen, A Textron Company
Chris Wissinger
Facility/Environmental Manager
Attachments

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted I —
CERTIFICATE OF COVERAGE NO. NCG030306
FACILITY NAME Jacobsen. A Textron Company
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES: Tyler. Rushin
LABORATORY: Shea ly_Environmental Inc. Lab Cert. # 329
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
or ® Monthly' January (month)
RJ!C ff Iv ARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
�•• V ❑Zero -flaw ❑Water Supply []SA
FEB 0 3 2015 ®other C
None CENTRAL FILES
DWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -)
n No discharge this period ?2
outfall No.
Date Sample
1
Collected
(mo/dd/Yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar 0&G/
Total Petroleum
Hydrocarbons
Total Toxic
s
Organics
Benchmarks ==_>
_
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
Wool
01/12/1S
1.0
12 mg/L
8.9 su
0.0045 mg/L
<0.001 mg/L
0.031 mg/L
0.8 mg/L
--
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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.
° 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."
CHRIS WISSINGER
Name (Print name)
FACILITIES MANAGER
Title (Print title)
% - z
(Sig ture) (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 ma/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.
❑ No discharge this period ?2
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 ==a>
_
-
15 mg/L
100 mg/L or 50 mg/L*
610 — 9.0 SU
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017 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 11 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 ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mall an orldinal and one copy of this MR. Including all„ "No Discharae" reports, within 30 days of receipt of the lab results (or at end of monitorina 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 are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
_I - a r-if
(Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 12 • q -1
CERTIFICATE OF COVERAGE NO. NCG030306
FACILITY NAME Jacobsen, A_Textron Company
COUNTY Mecklenbur
PERSON COLLECTING SAMPLES: Tyler Ruston
LABORATORY: Shealy Environmental Inc. Lab Cert. # 329
Comments on sample collection or analysis:
None
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2014
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' month
RECEIVED
RGING TO CLASS ❑ORW ❑HQW []Trout❑PNA
RECEIVED []Zero -flow ❑Water Supply ❑SA
DEC 0 5 2014 ®Other C
CENTRAL FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
DWR SECTION
❑ No discharge this period
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
lead
Zinc
Non -Polar 0&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organicss
Benchmarks ===s
_
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0.03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
SW001
11/17/14
2.2S
160 mg/L
7.83 su
0.040 mg/L
0.0056 mg/L
0.270 mg/L
0.8 mg/L
--
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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.
° See General Permit, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies,
5 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/l/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 Poliution 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), 1 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."
CHRIS WISSINGER
Name (Print name)
FACILITIES MANAGER
Title (Prl t title)
9� ,Z. jI`/Y
(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, the must be reported in the format. "<XX mg%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.
No discharge this period
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G/TPH by
EPA 1664 (SGT-HEM)
Total Suspended Solids
pH
Benchmarks =__>
_
-
15 mg/L
100 mg/L or SO mg/L*
6.0 — 9.0 SU
NA
NA
NA
NA
NA
NA
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: 11/1/2012-10/31/2017 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,
a 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:
Mail an or1 anal and one copy o this DMR lncludln all "No Dlschar e" re orts wlthln 30 da s o receipt o the lab results or at end o monitor1 erlod
In the casg o "No Discharge" reports) to.
Division of Water Quality
Attn: DWQ Central Files
1617 Mall 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 are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
Permit Date: 11/1/2012-10/31/2017
j Date)
SWU-245, last revised 10/25/2012
Page 3 of 3

APPENDIX 2
Forms and Data to Be Included in Annex F of the Jacobsen Facility One Plan

sm
A

TIER ONE/TWO/THREE STORMWATER RESPONSE
DOCUMENTATION RECORD
Directions: Complete this form in entirety if an analytical benchmark is exceeded.
Records: The general stormwater permit requires that this fora be maintained in the
facility's SWP3.
L Compliance Dates
a. Samples collected
b. Sample results received
c. Tier stormwater management inspection due
(must be within 2 weeks of date above)
d. Tier stormwater management inspection
conducted
e. Implementation of selected actions deadline
(must be within 2 months of date "d" above)
1I. Data
P—ate
11 /24114
12/08/14 _
Current
Previous 1*
Previous 2*
Outfall No.
Parameter
Benchmark
Value/Units
Analytical
Result
Results
Date i—I I
Results
Date =-7" ]y
Value/Units
Value/Units
Value/Units
SW001
5 5
90
O
4�2
`•�
._._
• ©D 7
• 0 `4
o 4
* if Previous 1 result was also dxIceded, then implement Tier Two monthly monitoring. Continue until current, Previous 1 and
Previous 2 results arc all under the benchmark_ If during permit term, analytical results indicate benchmark exceedance for any
specific parameter at any specific outfall four (4) times, the outfall is considered to be in Tier 3 and written notice should be sent to
the DWQ Regional Supervisor within 30 dam of the fourth sampling result
HL Inspection Results
Conduct an inspection of the drainage area to the oudfall and record the date in "d" above_ Person(s) conducting inspection
or
a. Identification of possible uses of exceedance •
ri
V
b. Identification of possible controls/improvements (iden 'fy at least one)
W Source Control U.! fig-E.�
hper tional Controls -I^i 0. 1L Cx im at v l 6
O Physical improvements
❑ Other - -
W. Implementation Record
Describe the actions completed to address the exceedance. If exceedance reoccurs in the next sampling, Tier Two actions are
-.....,. r: .r .
V. Maintain this form in the SWP3 per general Stormwater permit requirements.

NON -STORM WATER DISCHARGE ASSESSMENT AND CERTIFICATION
Jacobsen A Textron Company., Charlotte NC
Date of
Test or
Evaluation
Outfall Directly Observed
During the Test
(Identify as indicated on
the site map)
Method Used to
Test or Evaluate
Discharge
Describe Results from Test
for the Presence of Non-
Storm Water Discharge
Identify Potential
Significant Sources
Name of Person
Who Conducted
the Test or
Evaluation
SW 001
� � p u.J
Cl W � s � i ;✓
CERTIFICATION
LS�� �,r , certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a.syst�m designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of
the person or persons who manage the_system, or those persons directly responsible for 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 fine and im risonment for knowing violations.
A. Name & Official Title (type or print)
C _ 4c, r
B. Area Code and Telephone No,
7t'' - -S9 TY
C. Signature
D. Date Signed
C-z� -�9
G—h
C/

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGb30000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG030306
FACILITY NAME Jacobsen, A Textron Company
COUNTY Mecklenburg*
PERSON COLLECTING SAMPLES: Tyler Rushin
LABORATORY: Shealy Environmental Inc. Lab Cert. # 329
Comments on sample collection or analysis:
None
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2014
SAMPLE PERIOD ® Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
❑Zero -flow []Water Supply []SA
®Other C
9 ECEIVEQLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
MAY 0 2 2014
1hin AL FILES
.. n1A
No discharge, this period?z
rl
n
outfall No,
Date Sample
Collected'
(mo/dd/yr)
24-flour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Copper
Lead
Zinc
Non -Polar O&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organics
Benchmarks =__>
_
-
100 mg/L or 50 mg/L
6.0 — 9.0
0.007 mg/L
0,03 mg/L
0.067 mg/L
15 mg/L
1 mg/L
sW0o1
04/07/14
2.25
8.7 mg/L
7.8 su
0.0089 mg/L
0.0013 mg/L
0.060 mg/L
<5.0 mg/L
--
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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
MO), 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."
CHRIS WISSINGER
Name (Print name)
FACILITIES MANAGER
Title (Print title) _.
L 9 -A Lf
(Signature) V (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 ma/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 Z 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.
❑ No discharge this period?'
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
NA
NA
NA
NA
NA
NA
(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:11/1/2012-10/31/2017 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 I, Tier Z or Tier responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART Il 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:
Mail an original 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 $IGN 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 are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
G
(Signature of Permittee
Permit Date:11/1/2012-10/31/2017
4-301 3
(Date)
SWU-245, last revised 10/25/2012
Page 3 of 3

0"�
J/�COBS.N
A Textron Company
When Perforakw3ce hfttters""
April 30t" 2014
Division of Water Quality
Water Quality Section
ATTENTION: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
To Whom It May Concern:
11524 Wilmar Blvd.
Charlotte, NC 26273
phone: 704,504.6600
www.jacobsen.com
Attached are a completed original and one (1) copy of Jacobsen's Stormwater Discharge Outfall
(SDO) Monitoring Report form from the stormwater sampling event conducted at our facility on
April 7, 2014.
Sincerely,
Jacobsen, A Textron Company
Chris Wissinger
Facility/Environmental Manager
Attachments

NCDENR FIL.E
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Chades Wakild, P.E. John E. Skvada, III
Governor Director Secretary
July 3, 2013
Chris Wissinger, Facility Engineer
P.O. Box 7708
Charlotte, NC 28241-7708
Subject: Compliance Evaluation Inspection
Jacobsen — A Textron Company
11524 Wilmar Boulevard, Charlotte, NC 28273
NPDES Stormwater Permit NCG030000
Certificate of Coverage — NCG030306
Mecklenburg County
Dear Mr. Wissinger:
On February 26, 2013, Jeff Mitchell from Charlotte -Mecklenburg Stormwater Services (CMSWS), conducted a
site inspection of the Jacobsen facility located at 11524 Wilmar Boulevard in Charlotte, Mecklenburg County,
North Carolina. The site drains to Steele Creek, Class C waters located in the Catawba River Basin. The site
visit and file review revealed that the subject facility is covered by NPDES General Stormwater Permit —
NCG0300o0.
This inspection was conducted as part of a cooperative working agreement between Mecklenburg County and
the Division of Water Quality. In addition, the inspection was conducted on behalf of the City of Charlotte in
compliance with the City's NPDES Permit, NCS000240, Part II Section H. The following observations were
noted during the Charlotte -Mecklenburg Stormwater Services inspection (please see the attached addendum
for information about your permit):
1) Stormwater Pollution Prevention Plan (SPPP)
A Stormwater Pollution Prevention Plan (SPPP) has been developed, recorded, and properly implemented.
Yes ® No ❑
Please review the noted recommendations in the enclosed report regarding the list of significant spills and the
annual review/update of the SPPP.
2) Qualitative Monitoring
Qualitative monitoring has been conducted and recorded in accordance with permit requirements.
Yes ® No ❑
— 3) Analytical Monitoring
Analytical monitoring has been conducted and recorded in accordance with permit requirements.
Yes ® No ❑ NA ❑
4) Pennit/Outfalls:
Please see the recommendations noted in the attached report regarding the woody vegetation and cattails
noted in the dry detention basin.
Mooresville Regional Office
Location; 610 EastCenterAve„ Suite 301 Mooresville, NG 28115
Phone-, (704) 663-16991 Fax: [phone] Customer Service:1-877-623-6748 7 `. .
Internet; httpJ1portal.ncdenr.orglvrehlwq �i1 [i 3�01111c
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Chris Wssinger, Jacobsen
Compliance Evaluation Inspection, Page 2
July 3, 2013
Thank you for the assistance and cooperation during the inspection. Overall, the facility's Stormwater program
was well developed and implemented and this Office commends the permittee's efforts to ensure compliance
with your NPDES permit.
If you have any questions, comments, or need assistance understanding any aspect of your permit, please do
not hesitate to contact Jeff Mitchell with CMSWS at [phone] or Ms. Marcia Allocco of the Division of
Water Quality at [phone].
Sincerely,
for Michael L. Parker
Regional Supervisor
Surface Water Protection Section
Mooresville Regional Office
CC: Rusty Rozzelle, MCWQP
Craig Miller, City of Charlotte
Water Quality Central Files
Mooresville Regional Office
Location: 610 East Center Ave., Smite 301 Mooresville, NC 28115
Phone: [phone] Fax: [phone] Customer WOW,
Internet httpJ1portal.nodenr.org4e6lwq
An Equal Opportunity 1 AffirmativeAdan Employar— 30% Recycled110% Post Consumer paper
Lm a N-
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Chris Wessinger, Jaoobsen
Compliance Evaluation Inspection, Page 3
July 3, 2013
ADDENDUM
The National Pollutant Discharge Elimination System (NPDES) program was established under the federal
Clean Water Act and then delegated to the Division of Water Quality for implementation in North Carolina. The
NPDES permitting program for stormwater discharges was established in 1990. Phase I focuses on site and /
operations planning to reduce pollutant sources.
Through the NPDES permitting program industrial facilities that fall into one of the subject ten categories are f
required to obtain permit coverage under a general permit or an individual permit, depending upon the
facilities SIC code and the industrial activity occurring at the facility. There are currently 19 active general
stormwater permits in North Carolina. One condition that is applicable to both the general permits and
individual stormwater permits is the requirement to develop and implement site -specific comprehensive
Stormwater Pollution Prevention plans (SPPP). These plans are required to include a comprehensive
evaluation of the site and operations to reduce pollutant sources and prevent pollutant discharge.
Copies of the general permits and accompanying documents can be accessed from the following webpage:
http:Hportal.ncdenr.org/web/wq/ws/su/npdessw#General_Permits_NPDES. Permit text, technical bulletins,
discharge monitoring forms, and a Notice of Intent [which is the application for coverage under a NPDES
General Stormwater Permit) can be found on this website.
The following items are a subset of permit requirements and are listed to assist you and help bring your
attention to certain permitting issues, process and condition requirements of your permit. Please see the
above mentioned website to obtain a copy.of the permit so you may fully comply with all the conditions therein.
Failure to properly comply with conditions of the permit, like those bulleted below, is a violation(s) of
the permit and subject to civil penalty assessment(s) of up to $25,000.00 per day.
• Industrial facilities that fall into one of the subject ten categories are required to obtain permit coverage
under a general NPDES stormwater permit or an individual NPDES stormwater permit
• All persons desiring to have facilities covered by a General Permit must register with the Division of
Water Quality (DWQ) by fling of a Notice of Intent (NOI) and Applicable Fees.
• This Notice of Intent (NOI) must be submitted and a Certificate of Coverage issued prior to any
discharge of stormwater associated with the industrial activity, process wastewater, and/or mine
dewatering.
• Once the Notice of Intent is received, DWQ will review and determine whether a Certificate of Coverage
(COC) may be issued. If this Certificate of Coverage is issued the facility is covered by the General
Permit. That is, the permittee is authorized to discharge stormwater, process wastewater, and/or mine
dewatering pursuant to the type of General Permit until the permit expires or is modified or revoked.
• Any other point -source discharge to surface waters -of the state is prohibited unless it is an allowable
non-stormwater discharge or is covered by another permit, authorization, or approval.
• There are currently 19 active general permits. Permit conditions vary accordingly; however, most of the
permits have the following condition requirements (you must read your entire permit to ensure full
compliance):
o Development and compliance with the Stormwater Pollution Prevention Plan
o Collection, reporting, and recording of Analytical Monitoring
o Collection, reporting, and recording of Qualitative Monitoring
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115 e .
Phone: [phone] Fax: [phone] Customer Service: l 877�623-6748
Internet httpJ1portal.ncrfenr.orghveb&q O �,..,&O/i/ilic`�
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Chris Wissinger, Jacobsen
Compliance Evaluation Inspection, Page 4
July 3, 2013
o Collection, reporting, and recording of Vehicle Maintenance Monitoring (if applicable)
o Records - Visual monitoring shall be documented and records maintained at the facility along
with the Stormwater Pollution Prevention Plan. Copies of the analytical monitoring results shall
also be maintained on site. The Permittee shall retain records of all monitoring information,
including all calibration and maintenance records and all original strip -chart recordings for
continuous monitoring instrumentation, and copies of all reports required by this general permit
for a period of at least 5 years from the date of the sample measurement, report, or application.
o Expiration - The permittee is not authorized to discharge after the expiration date of the general
permit. In order to receive automatic authorization to discharge beyond the expiration date, the
permittee shall submit forms and fees as are required by the agency authorized to issue permits
no later than 180-days prior to the expiration date. Any permittee that has not requested
renewal at least 180 days prior to expiration, or any permittee that does not have a permit after
the expiration and has not requested renewal at least 180 days prior to expiration, will be
subject to enforcement. Failure to renew your permit is a violation.
o Transfer - The Certificate of Coverage (COC) issued pursuant to this general permit is not
transferable to any person expect after notice to and approval by the Director. The Director may
require modification or revocation and reissuance of the Certificate of Coverage to change the
name and incorporate such other requirements as may be necessary under the Clean Water
Act. The Permit is NOT transferable.
o Name Change, Closure, or Facility Ownership change - Permittee is required to notify the
Division in writing in the event the permitted facility is sold or closed. The Division of Water
Quality views changes of name or ownership as a modification that requires the Director's
approval and reissuance of the permit. Name and ownership changes require you to complete a
Name/Ownership Change Form from the Division and mail it back to the Division of Water
Quality along with all appropriate information.
o Proper Operation and Maintenance is a requirement of the permit.
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115
Phone: [phone] Fax (704) 653WO I Customer Service:1-8n-623-674&
Internet httpJ1portal.ncdenr.orghvebt*q
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Compliance Inspection Report
Permit: NCG030306 Effective: 11/01/12 Expiration. 10/31/17 Owner: Jacobsen Textron
SOC: Effective: Expiration: Facility: Jacobsen Textron
County: Mecklenburg 11524 Wilmer Blvd
Region: Mooresville
Charlotte NC 28241
Contact Person: Chris Wissinger Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Certification: Phone:
Inspection Date: 02126/2013 Entry Time: 09:00 AM Exit Time: 12:00 PM
Primary Inspector:. Water Quality Program Meckenburg County Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Metal Fabrication Storrnwater Discharge COG
Facility Status: ■ Compliant Q Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Page: 1

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Permit: NCGO30306 Owner - Facility: Jacobsen Textron
Inspection Date: 02I26/2013 Inspection Type: Complianoe Evaluation Reason for Visit: Routine
Inspection Summary:
Facility Description:
The Jacobsen facility manufactures turf equipment_ The facility has an active Chartotte-Mecklenburg Utilities (CMU)
Industrial Pretreatment Permit (#3006).
Compliance History:
The facility was inspected on February 15, 2008, by Charlotte -Mecklenburg Storm Water Services (CMSWS). The facility
was found to be compliant with the general stormwater permit requirements.
Industrial Operations/City of Charlotte Stormwater Ordinance Review -
Aboveground Storage Tanks (ASTs) —
The facility has two 1500-gallon ASTs (Greens Care 68 and 10w30 oil), one 1000-gallon AST of Greens Care 46 and four
750-gallon ASTs (used oil, antifreeze, Azolla 25 and 68 orange). The above ASTs are made of steel and located outdoors
under a roof within a containment wall_ Two 547-gallon double wailed ASTs (diesel and gasoline) are made of steel and
located outdoors under a roof within a containment wall. Concrete bollards surround the containment wall to provide
collision protection.
Outdoor material storage area(s) —
At the time of the inspection, the materials stored outdoors consisted primarily of pallets and shrink wrapped tires. No
deficiencies were noted in these areas.
Outdoor processing area(s) —
The facility has a small track and a single golf course hole where lawnmowers are tested. No stormwater issues were
observed in this area.
Loading/Unloading area(s) —
There are approximately eight loading bays and no stormwater issues were observed in this area.
Vehicle/equipment area(s) -
Ail turf and lawn equipment were stored indoors at time of the inspection.
Waste storage/disposal areas (dumpsters, scrap metal bins, etc.) —
A parts metal bin was observed outdoors under a roof. Two trash compactors and a cardboard dumpster were observed.
No stormwater issues were observed.
indoor processing area(s) --
Fabrication of lawn equipment is performed indoors. The process consists of cleaning plate metal, bending, cutting,
welding, painting and assembly of parts. No deficiencies were observed in this area.
Page: 2

N
Permit: NCG030306 Owner - Facility: Jacobsen Textron
Inspection Date: 02126/2013 Inspection Type: Compliance Evaluation
Stormwater Pollution Prevention Plan
Does the site have a Stormwater Pollution Prevention Plan?
# Does the Plan include a General Location (USGS) map?
# Does the Plan include a "Narrative Description of Practices"?
# Does the Plan include a detailed site map including outfall locations and drainage areas?
# Does the Plan include a list of significant spills occurring during the past 3 years?
# Has the facility evaluated feasible alternatives to current practices?
# Does the facility provide all necessary secondary containment?
# Does the Plan include a BMP summary?
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
# Does the facility provide and document Employee Training?
# Does the Plan include a list of Responsible Party(s)?
# Is the Plan reviewed and updated annually?
# Does the Plan include a Stormwater Facility Inspection Program?
Has the Stormwater Pollution Prevention Plan been implemented?
Reason for Visit: Routine
Comment: The permittee has a Spill Prevention Control and Countermeasure (SPCC)
Plan. The SPCC Plan was not reviewed during this inspection. The SPPP states the
facility has not had any significant spills and appears to have been updated annually.
The SPPP also states that a separate sheet will be maintained to document whether
any spills have occurred. It is recommended the permittee complete the form on an
annual basis with the annual review/update of the SPPP_ A review of the revision dates
throughout the SPPP indicates the SPPP is updated on an annual basis. It is
recommended the permittee add an update/amendment page to the SPPP to clearly
indicate the updates and changes made to the SPPP.
Qualitative Monitoring
Has the facility conducted its Qualitative Monitoring semi-annually?
Comment:
Analytical Monitoring
Has the facility conducted its Analytical monitoring?
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
Yes
No
NA
NE
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Page: 3

Permit: NCG030306 Owner - Facility: Jaoobsen Textron
Inspection Date: 02f26/2013 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Comment: Neither vehicle nor equipment maintenance is performed on site, but the
facility does fill completed lawn equipment with oil and fuel prior to shipping the
equipment. It is estimated the facility uses greater than 55 gallons of new oil per month
averaged over a calendar year.
Permit and Ouffalls
YPc Mn NO NF
# Is a copy of the Permit and the Certificate of Coverage available at the site? ■ 0 Q Q
# Were all outfalls observed during the inspection?
■n❑n
# If the facility has representative outfall status, is it property documented by the Division? 0 ❑ ■ n
# Has the facility evaluated all illicit (non stormwater) discharges?
Comment: The stormwater drainage system consists of open ditches, drop inlets and
underground stormwater pipes that discharge to a dry detention basin. No deficiencies
were observed with the stormwater drainage system. The basin has a single two -foot
outlet pipe. Woody vegetation was observed behind a rock check dam near the outlet
pipe and along the bank above the outlet pipe.'Cattails were observed near the rock
check dam. The permittee should remove the woody vegetation and consider removing
the cattails and repairing the basin to prevent it from retaining water and allowing the
growth of cattails (could create mosquito breeding grounds).
■n0El
Page: 4