540122_Other_20230524

Change of Swine Integrator Registration Form
Farm Name: -, ' g%,,, 4t -j
Facility Number:— - 1
Physical Location of the Swine Farm:
Owner(s)Name: I Ne\con Jm`A
Mailing Address: -
City, State, Zip Code:--
Grower(s) Name if different than Owner:
Mailing Address: _ . --
City, State, Zip Code:. ---
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Current/NewIntegrator: 6r1
Integrator Contact Name: r% -e
Mailing Address: S la-. - -
City, State, Zip Code: l._
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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