670029_Other_20230501

Change of Swine Integrator Registration Form
Farm Name: —DcAv i S ter "^
Facility Number: (.P-1 D.9
Physical Location of the Swine Farm: _ 3 7 9L �Cn. V ► �. _
Owner(s) Name: r O �J •�G- r `� S �--�
Mailing Address: 3 S V i S .
City, State, Zip Code:
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zip Code:
Phone: q kO-' cSct-r .Lg .%. Email: -�bLr r�Q -c an.�j C;k (+r,OLI
Current/New Integrator:
Integrator Contact Name: o-v : c1 - S Vt�r'
Mailing Address: �• ��„L �S
rr
City, State, Zip Code:
Phone: Ql i D - D33 - 3 4 3�Vmai1: K �+-� 2S �o ►-� S m �� . o .,-,
We appreciate your cooperation. This information
you have any questions contact the AFO Unit at (91
-23
Date
aired in accordance with G.S. 143-215.10H. If
-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