470006_Other_20210401

Change Of Swine Integrator Registration Form
Farm Name: Va acy S
Facility Number: 47 - 06
Physical Location of the Swine Farm: 6141 ,4 e 4a pi.
Owner(s) Name: 0 Aloa
Mailing Address: £O e,,rna,r+� t !'r �► Pe(
City, State, Zip Code: ifursS AL N2911
Grower(s) Name if different than owner:
Mailing Address:
City, State, Zip Code:
Current Integrator: !V - t. ) r /i inn
Integrator Contact: area 72vrv/s
Mailing Address: of 5 0 Spies /2
City, State, Zip Code: IC.a Lis 8n c , /v . 4
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Owner's@ignature Da' e
We appreciate your cooperation. This information is required in accordance with
G.S. 143-215.10H. If you have any questions contact the AFO Unit at (919)
807-6464, otherwise please return this forrn to:
NC Division of Water Resources
Aquifer Protection Section
Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, NC 27699-1636