250042_Other_20230511

Change of Swine Integrator Registration Form
Farm Name: 1,(14 _� nt- Sep_ _
Facility Number: cl S - 4
Physical Location of the Swine Farm: 3 a O i-\ U g r u
\'')o v- IRL '1 5 aV
Owner(s)Name: 0 TOY4-
Mailing Address: 305 i Si APO r 1C, LL
City, State, Zip Code: e Y n,C_ aB S of L
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zip Code: _
Phone: aSa- l.-lO-545maiL_mr�a�en
Current/New Integrator:
Integrator Contact Name: _ Vvo-\1 : n \ 3,.3 2 S Vbr-%
Mailing Address: () • b '65 LQ
City, State, Zip Code: lx �p,,c cc-uJ Y-1 3g (�s
Phone: 0-%11U-a53-94Ptmail: i(W2S1°n�St+-,.}�
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We appreciate your cooperation. This information is required in accordance with G.S. 143-215.1OH. 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
ELECTRONIC SUBMISSION IS ENCOURAGED. PLEASE EMAIL TO: RAMESH.RAVELLAQNCDENR.GOV
CISIR 03-25-2021