960179_Other_20210527

Change Of Swine Integrator Registration Form
Farm Name: Elroy Farm Facility Number: AWS-960179
Physical Location of the Swine Farm: 178 Chester White Drive, Seven Springs, NC,
28578
Owner(s) Name: Ivey's Spring Creek Farm, Inc.
Mailing Address: 314 NC Hwy 111 S
City, State, Zip Code: Goldsboro, NC 27534
Grower(s) Name if different than owner: N/A
Mailing Address: N/A
City, State, Zip Code: N/A
Current Integrator: Ivey Cherry Creek Farms, LLC
Integrator Contact: Robert Ivey
Mailing Address: 314 NC Hwy 111 S
City, State, Zip Code: Goldsboro, NC, 27534
Owner's Signature
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 form to:
NC Division of Water Resources
Aquifer Protection Section
Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
CISIR 12-15-05