670053_Other_20230601

Change of Swine Integrator Registration Form
Farm Name: UZ
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Facility Number:
Physical Location of the Swine Faun:: � C) r� � ► �_� -•
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Owner(s)
Grower(s) Name if different than Owner:
Mailing Address: --- - ..
City, State, Zip Code:. _
Phone:1?,kQ- Q ILA - 3 2. c1 v Email: S-A i � Ca
C went/New Integrator:
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Integrator Contact Name: \J 1 c-N f S in
Mailing Address: • '-'a> b, L '6(o ---
City, State, Zip Code: r'v.t� 53, c Y, C... -
Phone: °t i'U - 93 - 343` mail: C_ o w-,
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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 Center
Raleigh, NC 27699-1636
ELECTRONIC SUBMISSION IS ENCOURAGED. PLEASE EMAIL TO: [e-mail]
CISIR 03-25-2021