NCC192757_Contact Update Record_20201206

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Georgoulias, Bethany 12/6/2020 1:43:56 PM (Contact Changes Submitted)

Certificate of NCC192757
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2019-2757
Original NOI No.* 18331
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
MCAS Cherry Point
Project Name
Repave Range Road South
Address
Range Road, Cherry Point, NC
County
Craven
Latitude
34.9195
Longitude
-76.8772
Date COC Issued*
11/18/2019
Prior Rescission
This field will populate only if OOChas already been rescinded.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
Charles Schulz
Individual
(Previous)
First Name (New)*
Anthony
Last Name (New) *
Ference
NEW Legally
Reflects any revisions above
Responsible
Anthony Ference
Individual*
Permittee Email
[e-mail]
(Previous)
NEW Permittee
[e-mail]
Email *

Permittee 2524663148
Telephone No.
(Previous)
NEW Permittee 252-466-3807
Telephone No.*
Permittee Mailing P.O. Box8006, 0, Cherry Point, NC 28533-
Address (Previous) 0006
NEW Permittee
Mailing Address*
Street Address
P.O. Box 8006
Address Line 2
City
Cherry Point
Fbstal / Zip Code
28533-0006
Permittee Street Building 1 C Street, 0, Cherry Point, NC
Address (Previous) 28533-0006
NEW Permittee Street Address
Street Address* Building 1 C Street
Address Line 2
City
Cherry Point
Fbstal / Zip Code
28533-0006
State / Rovince / Fbgion
NC
Country
United States
State / Rovince / Region
NC
Country
United States
Change Requested Anthony Ference via Modification request submitted 12/3/2020.
by: * Include any additional correspondence records in the Repository 00Cfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 12/06/2020