520027_Other_20230601

Change of Swine Integrator Registration Form
Farm Name:.r
Facility Number:J�a.
Physical Location of the Swine Farm:
Owner(s) Name: _ _.��. ..: m....... —.. w.....�..w...__ ..._._.. ............. ..... ..
Mailing Address: .� .........'.
�e City, State, Zip Code:
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zip Code:
Phone: arja- 2.S to -L17.4 a. Email: �! 'P
Current/New Integrator: — —s" w .� W.. ..
Integrator Contact Name•Q v A. r mmmm f Sri
Mailing Address:....... _5
City, State, Zip Code:.., v 1n—_�._....$ Q.... w. .
Phone: cl 1 O— a q 3— 3 4 3LVmail:
Owner's Si
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 RECERM
1636 Mail Service Center
Raleigh, NC 27699-1636 MAY 2 6 2023
ND D
ELECTRONIC SUBMISSION IS ENCOURAGED. PLEASE EMAIL TO: RAMESH.RA�M NR.GOV
CISIR 03-25-2021