540062_Other_20230601

Change of Swine Integrator Registration Form
Farm Name:
Facility Number: 9r j -- lQ ., ,.._
Physical Location of the Swine Farm: _ -14 1 1 an'p-', 2) � i `�z. o..� a E %
e2L -IS
Owner(s) Name:
Mailing Address: 3 L'-t ]a
City, State, Zip Code: _ _ ��_i r \, wA �r � C_ 'a' a 5 1],
Grower(s) Name if different than Owner.
Mailing Address:
City, State, Zip Code:
Phone:?5;5P1- 1181 Email:, r -Srnr �r r►-ti ��Qmb ��• I.c� ram+
Current/New Integrator:
Integrator Contact Name: v : S kbr.
Mailing Address:, 'C6-45 L
City, State, Zip Code: ��� S gem u ---) L= Ck
Phone: 0 1 L) - a R 3 `.S434�nail:
We appreciate your cooperation. This information is required in accordance with G.S. 143-215.I0H. 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 MAIL TO: RAMESH.RAVELLA [e-mail]
CISIR 03-25-2021