310443_Other_20230522

Change of Swine Integrator Registration Form
Farm Name:
Facility Number:
Physical Location of the Swine Farm: :3 00 t,')ona.t
Owner(s) Name:
Mailing Address: - C-iQ C_e. A P,- - he, r V1, L2,L.. _
City, State, Zip Code: ev�b, i �t n Z�- VS t 'S _
Grower(s) Name if different than Owner: .
Mailing Address:
City, State, Zip Code:
Phone: R10, aR - ` 01 Email: nv�\N 0 k--h C-N L o
Current/New integrator: _ -S t-cam', -�r� -Q- � � k-)Y3 c 'ro�ti�--L r1
Integrator Contact Name: ��Q, v ; r1 L N] -C S tsr�
Mailing Address:6 S -
City, State, Zip Code: �-k-)"C-sc—v_J_,r__Y'�.C_
Phone: Ck1D-aC0-943LFma : c-o
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 forth 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