310250_Other_20230614

Change of Swine Integrator Registration Yorm
Farm Name: V&-c rn
Facility Number: .3 k - X5 0
Physical Location of the Swine Farm: 'N QUIN
Owner(s) Name:
Mailing Address:
k
City, State, Zip Code: 5
Grower(s) Name if different than Owner:
Mailing Address:
City, State, Zip Code:
Jo-c-K pro--A+<<s «, 0-0 ern . I. 0_0 r,- %
Phone: AS A - aag - VA 0-1 Email:
Current/New Integrator:
Integrator Contact Name: -e S +n
Mailing Address:•] • b �L S _
City, State, Zip Code: nC_ 3�
Phone: C 1 D- a g 3- 9 4 3 an: w R-% Y, S r., 4k-,. '
Signature
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