310390_Other_20230605

Lnange of bwme integra-tor negis rauun rul m
Farm. Name:
Facility Number: _ 3 _ -
Np-C-0r-s
Physical Location of the Swine Fann: 14 i
LA
Owner(s) Name: Ea, �+ �R�-�ro�rm . �.r, (—
Mailing Address: o-'
City, State, Zap Code: ^rrY A. nklz �� ric— SUS —
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zip Code:
Phone: Email:
Current/New Integrator:
-,?-r
Integrator Contact Name: _��\3 , c-,, �-1 -e % �-bn
Mailing Address: �P• () • "-& ts CBS
City, State, Zip Code: Vk --) 06K cz, c— 1A L . 39�
Phone: Ql ti Q ! °13 - Sx OLVmai1: k w e-S'�'- r% �" �'► -�rL 1 L - L o xr.
IN
We appreciate your cooperation. This information is required in accordance with G.S. 143-21 S.I 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: RAMESHAAVELLA agNCDENR.GOV
CISIR 03-25-2021