670062_Other_20230427

Change of Swine Integrator Registration Form
Farm Name: -Do y oye-
Facility Number:
Physical Location of the Swine Farm:
Owner(s)Name: o !-A o
Mailing Address: --\ -
City,State,Zip Code: ;Q-\'. c,-,
Grower(s)Name if different than Owner: _
Mailing Address: - -_
City, State,Zip Code: _-_
Phone: R10---33b-111-1 Email: �i c�,n r�5�¢r�,S •�� C @ - r " �•-,
V
Current/New Integrator: r-c�'.��r� .�t c �'r� sf�
Integrator Contact Name: -e S +n
Mailing Address: • b�L C 5
City,State,Zip Code:
Phone:°li D-a 53-3-'i3Nmail: 1S.w R-s-�,-,�- scam-,► -�:�1�. Lo ,M-,
rz "2, .2-7 23
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(919)707-9129,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
ELECTRONIC SUBMISSION IS ENCOURAGED. PLEASE EMAIL,TO:[e-mail]
CISIR 03-25-2021