640074_IntegratorChange_20230605

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Change
Farm Name:
Facility Nnmber: —1-9—
PLysi71 Location of the Swine Farm:
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Owners) Name:
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Mailing Address:
City, State, zip fie• y —
Growers) Name if different than Owner.
Mailing Address:
City, State, Zip Code:
Phone:
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Integrator Contact Name: :f1 's
Mailing Address: �•
65 La
City, Statc, zap 1� C O
phone. S lu-
er's Signahrre Date
We appreciate your cooperation. This information is required in accordance with G.S. 143-215.10B. Lf
pal have any questions contact the AFO Unit at [phone], otherwise please return this form to:
NC Division of Water Resources
Water Quality Peamiging Section
Animal Feeding Operations
1636 Mail Service Cent=
Raleigh, NC 27699-1636
ELF:O'ROMC SUBWSSION IS ENCOURAGED. PLEASE El"a. TO: RAMESH.RAVEL LA(@3NCDEM-GOV
CISIR 03-25-2023