NCC191336_Contact Update Record_20201204

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany 12/4/2020 12:50:42 PM (Contact Changes Submitted)

Certificate of NCC191336
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2019-1336
Original NOI No.* 14737
Project information associated with this permit (cannot change):
Permittee Listed
Organizaitoncannot bechanged (new COCrequired)
The University of North Carolina at Chapel Hill
Project Name
UNC-CH OUTDOOR EDUCATION CENTER POND RETROFIT
Address
414 Country Club Rd, Chapel Hill, NC
County
Orange
Latitude
35.9070
Longitude
-79.0360
Date COC Issued*
08/14/2019
Prior Rescission
This field will populate only if CCChas already been rescinded.
Date
Which Contacts
F Legally Responsible Individual Only
Have Changed?*
f Site Contact Only
f BOTH Legally Responsible Individual and Site Contact
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Jonathan Pruitt
Individual
(Previous)
First Name (New)*
George
Last Name (New) *
Battle, III
NEW Legally
Pleflects any revisions above
Responsible
George Battle, III
Individual*
Permittee Email
[e-mail]
(Previous)
NEW Permittee
[e-mail]
Email *

Permittee 919-962-3795
Telephone No.
(Previous)
NEW Permittee 919-962-3795
Telephone No.*
Permittee Mailing Campus Box 1000, 0, Chapel Hill, NC 27514
Address (Previous)
NEW Permittee
Mailing Address*
Street Address
Campus Box 1000
Address Line 2
City
Chapel Hill
Fbstal / Zip Code
27514
State / Rovince / Fbgion
NC
Country
USA
Permittee Street 300 South Building - 200 E. Cameron Ave, 0,
Address (Previous) Chapel Hill, NC 27514
NEW Permittee Street Address
Street Address* 300 South Building - 200 E. Cameron Ave
Address Line 2
aty State / Rovince / Region
Chapel Hill NC
Fbstal / Zip Code Country
27514 United States
Change Requested Janet Clarke via e-mail on 12/4/2020.
by: * Include any additional correspondence records in the Repository CDC folder.
Additional Information for this update to contact information:
Addional Originally notified Program about this change in March 2020, before Modification
Explanation form was set up with option to provide paperwork for legally responsible person
(Optional) change. Confirmed contact details and all affected COCs on 12/4/2020.
Date * 12/04/2020