520027_Other_20230531

Change of Swine Integrator Registration Form JUE COpp
Farm Name: R V-N, TO.- X,
Facility Number: J�7. - an
Physical Location of the Swine Farm:
SAS S S
Owners) Name: -
Mailing Address: l NSAwx — Tr
City, State, Zip Code: c A
Grower(s) Name if different than Owner.
Mailing Address:
City, State, Zip Code:
Phone: As-5a- a.Sto -��.y a; Email: ❑ k06 s k
Cuawt/New Integrator.
Integrator Contact Name: ,Q Q : r -e S Vbr
Mailing Address: k. �i S
City, State, Zip Code: ��� r�� vJ YZ C_ 2k, 3Q
Phone: % O — a ck 3 — 943
�.-� � � r, � . s sr► ► �'SZ �l� . L o ,�.-,
Owner's
l S/A � /-2-i,
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