520032_Other_20230601

Change of Swine Integrator Registration Form
Farm Name:
Facility Numbea: S ?— - ;5;-1,_
Physical Location of the Swine Farm: "w S.
'tnt�1� 2
Owner(s) Name:
Mailing Address:
City, State, Zip Code. 2
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zip Code:
Emaaii:
Current/New Integrator:
Integrator Contact Name: \) ' r1 -E % kb+r.
Mailing Address: �• • "?> VS L2
City, State, Zip Code. obs vJ
Phone: at ! b - a 0 3 -- 9 4 YLf.mail:
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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 Centex'
Raleigh, NC 27699-1636
ELECTRONIC SUBMISSION IS ENCOURAGED. PLEASE EMAIL TO: [e-mail]
CISIR 03-25-2021