960185_Compliance_20220613

Change of Swine Integrator Registration Form
Farm Name: Q` Natt-er(
Facility Number: "1 - CAS
Physical Location of the Swine Farm; c - * ' S �14 i iQ k
Owner(s) Name: € y S S ! r t ram k t-- -11 12,th I.1 c
Mailing Address: 3` 5 al C. f 1 1 fj ate`
City, State, Zip Code: b /Is .? _ ( 2.
Grower(s) Narne if different than Owner:
Mailing Address: rnE
City, State, Zip Code:
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Phone: a �% Email: D 1 L Z° 'Q' S
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Current/New Integrator lean/ 1 evV Far S L
Integrator Contact Name: l M. i Cj(
Mailing Address: tt,, p i1'jri j 5C) 'h
City, State, Zip Code: i 10 it f So(x
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Phone: Cfl ,)qO ab(2 Email: ballCA' 10c)Ari 1i`a$i ►«ice
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Owner's Signature Date
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 [phone], otherwise please return this form to:
NC Division of Water Resources
Water Quality Permitting Section
Animal Feeding Operations
1636 Mail Service Center
Raleigh, NC 27699-1636
ELPCTRONIC SUBMISSION IS ENCOURAGED. PLEASE EMAIL TO: RAMESH.RAVELLA [e-mail]
CISIR 03-25-2021