540137_Other_20230426

Change of Swine Integrator Registration Form
Farm Name: XmrVILLA t--e.-,e__
Facility Number:-6.y_,_.,.
Physical Location oftheSwine Farm: Le Q PV5 )0 k-e 5 MIN N 1 1tc"-
Owner(s) Name:
Mailing Address:
City, State, Zip C(
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zip Code:
Phone: AS a - 5 Sq- 3 �,11 Email: <,� CLC-� Loa %S- p.s Cy ra V"00 I
t O "N
Current/New Integrator:
Integrator Contact Name: ,4^ V i ri
Mailing Address: �• n • >
City, State, Zip Code:
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Phone:%D-aCQ-9
?Tmail:
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Owner's
We appreciate your cooperation. This information is required in accordance with G.S. 143-215.1 OH. 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: [e-mail]
CISIR 03-25-2021