310572_Other_20230524

Change of Swine Integrator Registration Form
Farm Name: 75 A *as -
Facility Number: 3 1 - ID
Physical Location of the Swine Farm: CD
(l %►-ten t 1--d 7)i r-.. . n C-
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Owner(s) Name: �; L A ► �r
Mailing Address: —Z5 to O
City, State, Zip Code: , r-.ca, ,
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zip Code:
Phone: C( l O- a-11- l k kp � Email:
Current/New Integrator: f�->
Integrator Contact Name: P-,j -, r-1 -e S Vtwn
Mailing Address: �• 0 • —I?:::- tt,ti,L— _"dS U
City, State, Zip Code: V-�, _ .r,�r C c YZ L I3Q
Phone: % D - a CO - 343 e-+c- r, s M , ' .e—
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 [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