310856_Integrator Registration Form_20230602

Change of Swine Integrator Registration Form
Farm Name: tea-'�'+�*
Facility Number: 1_ _ -- $ 5 U
Physical Location of the Swine Farm: _
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Owner(s) Name: tv-,o c _ .LL(—
Mailing Address:
City, State, Zip Code: _ _ --
Grower(s) Name if different than Owner: _ �•.� �^{
Mailing Address:
City, State, Zip Code:
it, - _A%. a 7
Current/New Integrator:
Integrator Contact Name: �. \J : r-1 A N-) S
Mailing Address:.0 • --E> <6- �3 La
City, State, Zip Code: �=� as ":�, p- %k-D t YA C-- 7K $ Ck
Phone: Q - a S - 43 tmail: w s C-o -,
Owner's Signature
We appreciate your cooperation. This information is required in accordance with G.S. 143215.1 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
A imal Feeding Operations
1636 Mail Service Center
Raleigh, NC 27699-1636
ELECTRONIC SUBMISSION IS ENCOURAGED. PLEASE EMAIL TO: [e-mail]
CiSIR 03-25-2021