670013_Other_20230605

Change of Swine Integrator Registration Form
Farm Name: k } [ )JC 1" 0NfP 'r Vr rung
Facility Number: S.-1 - 13
Physical Location of the Swine Farm: ^ l �� : c3 S r�
D ag 5-14
Owner(s) Name: � r.,r , �, t �,� n 9 8r%
01
Mailing Address: 1 5 V-
City, State, Zip Code: --�z , '
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zip Code:
Phone: Ct 10 -'����mail: _ -�-�n� �e � ��ra. \ . C- k-�, '.'.
Current/New Integrator: 1-c�'� k-�b
Integrator Contact Name: V-\�Q -, n V--J -e S ri
Mailing Address: �• 0 • tzy `:6- S L
City, State, Zip Code:. f nC— 3Q
Phone: % D - a 1313 ` 943ail: 14w es-b r, C? 5 M•� � �.��� . Lo ,�
z3
Owner's Signature U 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