WQ0033357_Renewal (Application)_20221216

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0033357
ApplicantlPermittee S & J Villari Livestock, LLC
ApplicantlPermittee Address 892 Penny Branch Rd. Warsaw NC 28466
Is the owner in BIMS? Yes NO Is the facility in BIMS? Yes No
Owner Type
Facility Name
County
Fee Category Minor
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Organization
S & J Villari Livestock Class B Residuals Program
Duplin
Does this need review by the hydrogeologist? * Yes NO
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount
Complete App Date
$0
Below list any additional email address that need notification about a new project.
... ... ..
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Name* Gerald Matthews
Email Address*
[e-mail]
Project Information
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
19102897500
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
hftps://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Permit Number: *
WQ0033357
Has Current Existing permit number
Applicant/Permittee*
S & J Villari Livestock, LLC
Applicant/Permittee Address*
892 Penny Branch Rd. Warsaw NC 28466
Facility Name*
S & J Villari Livestock Class B Residuals Program
Please provide comments/notes on your current submittal below.
High -Rate Infiltration
Reclaimed Water
Residuals
Other
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
renew W00033357.pdf 6MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order and
made payable to the North Carolina Department of Environmental Quality (NCDEQ).
I also confirm that the uploaded document is a single PDF with all parts of the
application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature

Submission Date 12/15/2022

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one on final and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permittipzz Unit
General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include
water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Application Site Certification (FORM: LASC 06-16):
® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® For new or renewed permits, submit the requested information for all land application sites.
❑ For modified permits, submit the requested information for only those sites that are new, transferred or affected by the
proposed modification.
B. Land Application Site Information:
❑ The status of the land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
♦ New (N) ♦ Renewed (R) * Modified (M) ♦ Transferred (T) ♦ Deleted (D)
❑ Attach the following in accordance with each status code:
Status Code
Required Item
N
R
T
M
u�
County Board
Notification. doc
Landowner
'�
✓
✓
Agreement
(If applicable)
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "Map Guidance
for Residuals Land Application Permits- -
✓
✓
✓
A soils and agronomic evaluation in accordance with the "Soil Scjentist
Evaluation I'oiicv"
�
INSTRUCTIONS FOR FORM: LASC 06-16 Page l of 3

An updated accounting of the land application site's cumulative
pollutant loading rates CPLRs
Status Code
Required item
N
R
T
M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
✓
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soil Scientist EvalucldOn Poiicv"
Acknowledgement of field transfer from Land Owner (Fields may not
be permitted to multiple Permittees over the same timeperiod)
* This item may be required for land application site with a status code "M", please contact the Division if you need assistant in
determining attachment requirements.
❑ Crop Type should include the most likely crop types for the life of the permit (five years).
❑ Predominant Soils Series Name must be either the name of the soil indicated in Attachment "B" of the existing permit, or
name of the soil series as provided by the Iicensed soil scientist.
❑ Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
❑ For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
❑ New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
❑ Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD)
Aerial Photography with Ground Control (AER)
• Cadastral Survey (SUR)
• Conversion from Coordinate Plane (CP)
• Conversion from Township -Section -Range (TSR)
• Conversion from Universal Trans Mere (UTM)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
• Digital or Raw Photo Extraction (EXT)
• Geodetic Quality GPS Survey (GEO)
• LORAN-C Navigation Device (LOR)
• Navigation Quality GPS (GPS)
• Remote Sensing (RS)
• Zip Code Centroid (ZIP)
❑ Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: http://deq.nc.aov/about/divisions/water-
resources/ lannirtg classification-standards/classifications
❑ Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
❑ A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
h ://de .nc. ov/contactlregional-offices
❑ General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
3. Open the link h ://de .nc.gov/about/divisions/water-resources/ lanninE,/classification-standards/classifications.
❑ Stream Classification Process: One of the options below may be used depending on the known initial project information.
❑ KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of 3

2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple Iistings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2. Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams I SA NCAC 02B .0301 i .
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
Basin And Savannah
River drainage area entering South Carolina shall be classified "B Tr."
River Drainage Area
French Broad River
Streams entering Tennessee will be classified "B."
Basin
Watauga River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Streams entering Virginia are classified "C," and such streams entering South Carolina are
Basin
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
Roanoke River Basin
described shall carry the classification "B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall carry the
classification "C and B."
Chowan River Basin
Streams entering Virginia are classified "C."
Tar -Pamlico River
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
Basin
canals to Pamlico Sound and its bays which shall be classified "SC."
Pas uotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 06-16 Page 3 of 3

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State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
supyortina documentation
For more information, visit the Water Quality Permitting Section's Non-DischaLge Permitting Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 1.1-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC I I-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
❑ For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map Guidance For
Residuals Land Application Permits".
❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ For each source facility, attach the following:
❑ Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
❑ Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page I of 1

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State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: S & d Villari Livestock
2. Facility permit holder is: ❑ Federal, ❑ State, ❑ Local Government, or 0 Private.
Facility permit issued by: ® Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: ).
3. Facility contact person and title: Gerald Matthews
Complete mailing address: 892 Penny Branch RD.
City: Warsaw State: NC Zip: 28398-.
Telephone number: (910) 29-2157 E-mail address: Gerald.mavfgmail.corn
4. Facility physical address: 892 Penny Branch Rd.
City: Warsaw State: NC Zip: 28398-
Coordinates: Latitude: 350 0' 22" Longitude: 78' 7' 20"
Datum: Unknown Level of accuracy: Unknown
Method of measurement: Map interpretation by extraction
5. Purpose of the facility:
treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, Z treatment of 100% industrial wastewater,
❑ treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: % industrial and % domestic)
❑ other (explain: m }.
6. Does the facility have an approved pretreatment program: ® Yes ❑ No
7. Facility permitted/design flow: 0.1000260 MGD and facility average daily flow: 0.070000 MGD
8. Average amount of residuals being generated at this facility 11.6 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Biological slud a and grit remaining after solid separation rendered off -site and
facultative digestion in a 3 650 4428- gallon sy1ithetically lined lagoon and 1.88 million gallon above -ground stainless steel
storage tank.
Type and volume of residuals storage (i.e., outside of residuals treatment units):
H. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
ED 40 CFR Part 503 or 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
Z Biological ❑ Non -Biological
FORM: RSC 06-16 Page] of 5

Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes.
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal; domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: Q yes ® no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
26I.24: ❑ yes 0 no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Envirochem and Date of analysis: 2009-8-5
Passed corrosivity test: yes ❑ no. pH: s_u. (2 < pH < 12.5)
Passed ignitability test: yes ❑ no. Flashpoint: >212 IF (> 140°F)
Passed reactivity test: 0 yes ❑no. HCN: <0.115 mg/kg (<250) & H2S: 5.05 mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(Mg/1)
Result
(Mg/1)
Arsenic
5.0
2.98
Hexachlorobenzene
0.13
<0.005
Barium
100.0
0.120
Hexachloro-1,3-Butadiene
0.5
<0.005
Benzene
0.5
<0.05
Hexachloroethane
3.0
<0.005
Cadmium
1.0
0.345
Lead
5.0
<O.OIO
Carbon Tetrachloride
0.5
<0.05
Lindane
OA
<0.00005
Chlordane
0.03
<0.03
Mercury
0.2
0.002
Chlorobenzene
100.0
<10.0
Methoxychlor
10.0
<0.00005
Chloroform
6.0
<0.6
Methyl Ethyl Ketone
200.0
<0.05
Chromium
5.0
<0.010
Nitrobenzene
2.0
.<0.005
m-Cresol
200.0
<0.005
Pentachlorophenol
I00.0
<0.005
o-CresoI
200.0
<0.005
Pyridine
5.0
<0.005
p-CresoI
200.0
<0.005
Selenium
1.0
0.015
Cresol
200.0
<0.005
Silver
5.0
<0.010
2,4-D
10.0
<0.005
Tetrachloroethylene
0.7
<O.OIO
1,4-Dichlorobenzene
7.5
<0.75
Toxaphene
0.5
<0.05
1,2-Dichloroethane
0.5
<0.05
Trichloroethylene
0.5
<0.010
I,1-Dichloroethylene
0.7
<0.07
2,4,5-Trichlorophenol
400.0
<0.005
2,4-Dinitrotoluene
O.13
<0.005
2,4,6-Trichlorophenol
2.0
<0.005
Endrin
0.02
<0.0005
2,4,5-TP (Silvex)
1.0
<0.000033
Heptachlor and its Hydroxide
0.008
0.00154
Vinyl Chloride
0.2
<0.010
FORIM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e_, as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T _ 1105.
a. For Distribution/Land Application: Fill in the followin'. table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: Envirochem and Date of analysis: 2009-8-5
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
2.98
Cadmium
85
39
0.345
Copper
4,300
1,500
93.2
Lead
840
300
0.091
Mercury
57
17
0.032
Molybdenum
75
n/a
0.832
Nickel
420
420
5.91
Selenium
100
100
0.65
Zinc
7,500
2,800
682
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:.
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
❑ > 0 but < 25
30
200
210
❑ > 25 but < 50
34
220
240
❑ > 50 but < 75
39
260
270
❑ > 75 but < 100
46
300
320
❑ > I00 but < 125
53
360
390
❑ > 125
62
450
420
Result (mg/kg)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Mieronutrient Determination: Complete the following:
a. Total solids: %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Envirochem and Date of analysis: 2009-8-5
Parameter
Result
(mg1kg)
Aluminum
7,970
Ammonia -Nitrogen
1,950
Calcium
8,030
Magnesium
573
Nitrate -Nitrite Nitrogen
8.41
pH (Standard Unit)
7.29
Phosphorus
4,130
Potassium
673
Sodium
1,380
Total Kjeldahl Nitrogen
16,000
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 440
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 20 %. This
rate is a (check one): ® default value, or actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals: Same as current surface
irrigation ermit residuals are anaerobically digested.
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (11� Year PAN
Five -Year
(mg/kg}
Maximum Adjusted PAN
(mg/kg)
Surface
6,600
12,787.5
Injection/Incorporation
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses: None
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
❑ A fecal coliform density that is demonstrated to be less than 1,000 MPN per gam of total dry solids,
or
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
C] Alternative I [15A NCAC 02T. I 106(b)(3)(A)] - Time/Temperature Compliance.
[] Alternative 2 [15A NCAC 02T. I 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T. 1 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [15A NCAC 02T.I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment,
thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
Z Alternative 1 [15A NCAC 02T.1106(c)(1)] - Fecal Coliform Density Demonstration.
❑ Alternative 2 [15A NCAC 02T. 1 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, Q anaerobic digestion,
❑ composting, or ❑ lime stabilization.
C. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item Il. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 11. 7b. above.
❑ Exempt- If Daily Cover Alternative is chosen in Item 11.8. below [15A NCAC 02T.]106(a)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.I 107, specify how residuals will meet the VAR requirements:
® Alternative 1 [I5A NCAC 02T. 1 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T. 1 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [15A NCAC 02T. 1 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T_I 107(a)(5)] - I4-Day Aerobic Processes.
❑ Alternative 6 [15A NCAC 02T. 1 107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.1107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T.1107(a)(9)] - Injection.
❑ Alternative 10 [15A NCAC 02T. 1 107(a)(I 0)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.1107(b)(2)].
❑f Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 —RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: S & J Villari Livestock
Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Sam Villari Title: Owner
Applicant's mailing address: 892 Pma Branch Rd.
City: Wallace State: NC
Zip: 28398-
Telephone number: (2LO) 293-2157
Email Address: [e-mail]
2. Consultant's name:
License Number (for P.E.):
Affiliation: ❑ On Staff ❑ Retained (Firm:
Consultant's mailing address:
City: State:
Zip: -
Telephone number: (____)
Email Address:
3. Agronomist's name:
License Number:
Affiliation: ❑ NIA ❑ On Staff
❑ Retained (Firm:
Agronomist's mailing address:
City: State:
Zip: -
Telephone number: (__)
Email Address:
4. Soil Scientist's name;
License Number:
Affiliation: ❑ NIA ❑ On Staff
❑ Retained (Firm:. _
Soil Scientist's mailing address:
City: State:
Zip: -
Telephone number: (_) ___7
Email Address:
5. Fee submitted: (See Instruction B)
11. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ❑ modified, ® renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00033357
Date of most -recently issued permit: November 11 2017
Date of most -recently certified Attachment A (if different than the permit). -
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16 Page I of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 892 Penny Branch Rd.
City: Warsaw State: NC Zip: 28398-,
Coordinates: Latitude: 35' 0' 39" Longitude: 78' T 20"
Datum: Unknown Level of accuracy: Unknown
Method of measurement: Map interpretation by extraction
2. County where residuals land application program is headquartered: Duplin
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Gerald L Matthews
The Pork Company
1007103
Back -Up ORC
Ronnie Geno Kennedy Jr.
Agriment Services
17590
Additional Back -Up
ORCs
if ap Iicable
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summa : Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 11.6 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
I
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
13.2
153.1
Five -Year Maximum Adjusted
25.6
297.0
b. LandApplication Site Use Summar : Summarize information regarding the Iand application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
Row Crops
Hay
6.57
Pasture
Total:
6.57
Methods
Surface
6.57
Contract tanker spreader
Incorporation or Injection
Total:
6.57
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
qbs PAN/ac yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
3.06*
5.94
100
1.53
2.97
150
1.02
1.98
200
0.77
I.48
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.): N/A
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicates specify the following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified Iand application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
�n
Land Application Siite
Certification. doc
FORM: RLAP 06-16 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: 1_5 feet
below ground surface. Rules 15A NCAC 02T .0505(n) requires at least one -foot vertical separation between SHWT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
❑ Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
inlhr
Recommended
Loading Rate
inl r
6. Design loading rates are equal or Iess than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 15A NCAC 02T .0505(n) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field /Zone
Design Area
(ftZ
Number of
Nozzles
Maximum Application
Rate allons/hr
Design Annual Loading
Rate .gallons/ r
Total
Spray Irrigation Design Element
Plan Sheet
Number
Specification
I Pa a Number
Wetted diameter of nozzles
it
Wetted area of nozzles
ft2
Nozzle capacity
gpm
Nozzle manufacturer I model
I
Elevation of highest nozzle
ft
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing authority must he in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
® Yes ❑ No, Explain;
I, SgLUATW1L- V I LL.g2 ( rrl A tA; t r1G- Mcdvl R L
(Signature Authority's Name -- PLEASE PRINT) (Title)
attest that this application for ^�-t_ 3 V i L-L,4\ t, ( J_ i Vc.�_J- T-(J C te-4 L- L c
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes § I43-215.6A and § 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a CIass 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: 1�
FORM: RLAP 06-16 Page 5 of 5

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one oriZinaI and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitttng Unit,
General This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 1.5A NCAC 02T .1 100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer-
® Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: S&J Villari Livestock
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(Yes/no )
Land Use or
Cropping b Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
I-SSET
No
?????????????ry
??????????????
2-PIVOT
No
?.???????��.��
????????????ry?
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Palle 1 of

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third parry agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Penmittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the Iand application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
I3. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
IL RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2_ Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary_ Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale forthe requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site_
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new nro2ram:
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded Iandowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: Sam Villari
Address: 892 Pggny Branch Rd.
City: Warsaw State: NC Zip: 28398
Phone:
Signature:
E-mail address:
l Date: } 2 1 ' )
NORTH CAROLINA, D V, n COUNTY
I, the undersigned Notary Public do hereby certify that m 1,} �a r ,
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the _ ) C� A-V-,
day of �)qce
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
MM
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date:
FORM: LOA 06-16 Page 3 of

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ANALMOAL & CONSUIZING'
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4R"—QF ANALYM
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fm8!19;'201S -0: 6 e5G4687771 SJVILLAPI PAGE L.3
F?ug 13 OS 04.35pp Envincahem 9i.a9S244S4 P-2
nvixro=, ent l Chemists,Inca
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{�.ab) - (qi �92-4424 (Fxx)
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Customer- The Pork Co. Revert 9-ii279 rage 2 of 3
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1.':D.915179
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--
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1 Barium, B3 Ingll.
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i 0.12 i
08/05109
48 3sf 9
5.6
10.4
-0
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Chromium, Cr mg/
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<0.030
08{05109
I 08105109
5.0
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{ 0.002
08/07109
0-2
Seiegitru,Se mgfL
0.015
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silver. Ag m { < 0-0 1:
TCLP Herbicides & Fesdddcs
1.D. T 16179
I Ha and Leve3,
I mg!L
Chaarrlane < 0.03
3�nrlrin i 0.t�0005
cHeptac%1�r
! Lindsme
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0.40 -i
I++Ti�aoxyc�tyr
•� O.Dt�D�
14.40
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Date A mx! zed
0?13�31a9
'
I 7'CLF U:�grtnres
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� 0.0�'�
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Carbon Teti3chbride
<
C�3I£11 i?�TL'IIZCi3L
12I©raf4itr�
GeSol j
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< fl.003
I 241d7.0
: ©-003 200.0
'. � firecni i C fl-DCS ?��
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75
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BS
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-
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< Q.0,D5
Comments: 1P = Re3adve percent diff-emcee of the two cojumns greater thaxn 4a.

L;k:' 19f toes "Od: 46 e564687772 501VILLA,RI PAGZ' a4
Fvg 13 Oa D4:3Ep Envirrachem 9I03S24424- p.3
Environmental Chemists, Inc.
# s f 66D2 VrIndmflt Wax, NC 2a+F05
(", o ?92-4<24 (Fax)
710 5ow4Trnxvrt Poa6. •'Ianwo, NC »-R.34
�Na�r: �ca� d co�sstr�.rir�G
CHEMISTS
Customer: The Pork Co.
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Reaprt 9-6279
Page 3 & 3
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