520075_Other_20230524

Change of Swine Integrator Registration Form
Farm Name:
Facility Number: -52L-1'i
Physical Location of the Swine Farm:
Owner(s) Name:
Mailing Address: Vo t'e SA- -
City, State, Zip Code:
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zap Code:
Phone: a5 D 5 l'E-
Current/New Integrator. t-r\�. k-�D r �?X-
Integrator Contact Name: v : -e S+�'�
Mailing Address: --�>- C) - � t>>L S S L
City, State, Zip Code: Drro-{ S� YZL . $ 3Q �s
Phone: C D-a93-943 mail:_ �,��5�►'�ta 5n-,� - C-o.,,-,
�Y
Date
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