WQ0016376_Monitoring - 09-2022_20221122

Monitoring Report Submittal
Permit Number #* WQ0016376
Name of Facility:* S&J VILLARI LIVESTOCK PROCESSING FACILITY - WARSAW
Month: * September Year: * 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR WWT SEPT. 2022.pdf 8.23MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter: * Gerald Matthews
Signature:
Date of submittal: 11/22/2022
This will be filled in automatically
Initial Review
Reviewer: Gerald, Wanda

Is the project number correct?* WQ0016376
Is the monitoring report accepted?* Yes No
Regional Office* Wilmington
Reviewer: _anonymous
Review Date: 11/23/2022

0 R N aAR - 1 0 A- i I Win 4 ISCHARGZE 'AFM REPORT (NDAR- (9
0— =77—T
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N" C-1 C H A R G E, A!" P L A i 0 N-1 FREP ;R� N D A -

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�M�M: WDAR-1 08-H NSMS-CHAF-EGE APPLHCATION P--
P 0 - T IN jj-A- P

NON—USC,- .AR;31E: APPLP'--AT-l--,c'—`A-l'�l REPORT iP K-,)A...-T ge

FORM, NIP,"V4 08-11,

FORM NDAR-1 08-11
Page r of
Compliant Nnn-Comphant
® Compliant Nun Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? J Compliant pan Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? compliant Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in year pewit? Compliant Non -Compliant
If the facility is non -compliant. please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) o the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (CRC) Certification Permittee Certification
ORC: Gerald Lamar Matthews Permittee:
Sam 1lillar
Certification No.: 993131 Signing Official:
Grade: Si Phone Number. 910-289-7500 Signing Official's Title: Owner
Has the ORC changed since the previous NDAR-1? Yes No Phone Number: 910-293-2157 PermitExp.: 11/302025
Signature Date Signature Date
By this signature. l certify thatthis report is accurrate and complete to the best of my knoevledga, l certify. under penalty of law that this document and all attachments were prepared under my d€rectian or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. used on my
inquiry of the person or persons who manage the systear. or those persons dire Vv responsible for gaiher:ng the €nfornnafton, the
Information submitted is, to the best of my knowledge and beret, true, accurate. and �,ornplele I am aware :hat there are significant
penalties for subrn€tting false information. including the possibility of fines and imprisonment for Knowing wolaiio€as.
Mail Original and Two Copies to -
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

�,'o `-OA A: iN D M R G 3, - 12 N 201- N - D 55 'I'm A RG E ;Nl 0- N' T 0 R I N G REP 0 �- T N 0 W.

't, ,1, Vie.-=$-y7 `S ,.J „'. � �. <i'.a�7�i+�.+°'?,�' a, i... .#?�'3�# I'�i S'�5¥ f...> _�.."1_'i I {I'�#.d"�§� _ ( � _1�__l j{

>E AAONI T , iNz' REPORT UK

Page i
Sampling Person(s)
Name: GERALD ILAMAR MATTHEWS
Certified Laboratories
Name: Environmental Chemists INC.
Name: alter Agricultural Laboratories
Compliant Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the noncompliance and describe the corrective
action(s) taken. Attach additional streets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: GERALD LAMAR MATTHEWS Permittee: SAM VILL ARI
Certification No.: 993131 Signing Official:
Grade: Sl Phone plumber: 919-289-7500 Signing Official's Title: OWNER
Has the ORC changed since the previous NDMR? 2 Yes No Phone Number: 91 0-293-2157 Permit Expiration: 11/30/2025
Signature Gate Signature Gate
By this mgnature- I certify that this report is accurrate and co3nplete to the nest of my Knowledge. 1 certify, under penalty of law, that this document and all attar_hm.eats were prepared under icy direction or supervision in
accordance with a system designed to assure that all 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 fesponsibie for
gathering the information. the information submitted Is. to the best of my knovvredge and oeaef, true, accurateand complete.. i am
mvare that there are significant penances for submitting false information. inci.dinEt the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

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NON -DISCHARGE Im AS-S L-OADING R-IVPOE4121, MW i_R;l
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Perrr.jt No.; WQOO! 6376 i Fac-fl-RY Nasne.- '�&j Viflar Uv�-slock ID 1 u, 1: n Year- 2022
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FORM NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (N ML ) Rage S off®
tthe mass loading- of your M.
°ornpiant E Non-compiiant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your expiana ton the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessarv.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Gerald Lamar Matthews Permittee:
SAM VILLAF;I
Certification Number: 993131 Signing Official:
Grade: Sl Phone lumber: 910-289-7500 signing Official's Title: OWNER
Has the ORC changed since the previous NDMLR? Yes [' No Phone No.: 910-293-2157 permit Exp.; 11/30/25
Signature Date Signature Date
By this signature. ! certify that this report is accurrate and complete to the best of my knowledge. I certify, under penally of lawr that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel property 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 gathering the information. the information submitted is, to the best of my knowledge and belie*. true,
accurate, and complete. I any aware that there are significant penalties for submitting false information, including the
possibility of fines and imprisonment for knowing violations..
Mail Original and Two Copies to:
Division of Water Resources
Information Processing unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

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ENVIRONMENTAL CHEMISTS, IN OFFIC. 9°I_39222 1-3
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ANALYSIS REQUESTED
Date
Time Temp
g
a.
E
' --00 'Effluent- I /month)
r
D, TSS, N0
� H (geld aLZ
NO3NH3, TKN, Total P, PAN, Total l
'x
Fecal Cofform
a
- i i7 n
C
S
TDS, Chloride (tri-annuals �
P
0ryry
R
s
G._
[,y..
N fit.._{ ^p-y
03,
G
Fecal
JL
TKNH ,N0 :TRTH
-
, - - -
c
i
Fecal
5Samples due 11montl
Transfer
- -_R
a elin wished By:
Dadra
1� d y,
t 1Ti e
T
12.
Temperature when Received °
��A epted}
(
j t d:
_
Resi
Delivered '_
Received
-
Date;