960072_Other_20230525

Change of Swine Integrator Registration Form
Farm Name: er5 on to e! Car-r-
Facility Number: q (. -1;.
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Physical Location of the Swine Farm: XT k� 11n C2kraoK
L� �-.t-r..r.c•e r1C. ��551
Owner(s) Name:
Mailing Address:
City, State, Zip Code: n-GJT nc e� ass5 i
Grower(s) Name if different than Owner.
Mailing Address:
City, State, Zip Code:
Phone: qu{- 92L\- 1Ss U to Email: cAr 0.n� e �� (� C S1 e e a L�
Current/New Integrator:
Integrator Contact Name: � �-3 f % k-6r.
Mailing Address: �• () • --?=, b1L 6S (a
City, State, Zip Code: L> >r�r �, c-- $
Phone:%D-2L53-34?mail: KWe-5-�+'� °i Sr+-,'.'Y�-Y�.•�\� Lo.r-,
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