310580_integrator change_20230605

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Farm Name: V, L —i�'rt c_ �,-
Facility Number: _3_ 5 '(0
Physical Location of the Swine Farm: vs t.a.-�-� a� ` �'-'•
Owner(s) Name: _ �Q.V ► ti ► C.e�
Mailing Address: `�al
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City, State, Zip Code: e.r--lr 5❑ ' C— , D� �5
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zip Code:
Phone: Ol kA — Q 3 4 3 Email: Q ► C-1 o v
Current/New Integrator: 5 • V� kAD e Y �Px- o
Integrator Contact Name:.�y
CS LQ
Mailing Address: �• 6
City, State, Zip Code: $ 3R
Phone: Ql l D - a 5 3 ` 9 4 3$mail: _ k %0 e-S +;;� r-, 4A-1 �� o
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Owner's Signature
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Date
We appreciate your cooperation. This information is required in accordance with G.S. 143-215.1On. 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: RAMESH.RAVELLA@NCDE'NR.GOV
CISIR 03-25-2021