NCC214571_Contact Update Record (Legally Resp Change)_20220204

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 2/4/2022 2:31:40 PM (Contact Changes Submitted)

Certificate of
NCC214571
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2021-4571
Original NOI No.*
61840
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
SL Reedy Fork LLC
Project Name Reedy Fork Industrial
Address 5955 Summit Avenue, Greensboro, NC
County Guilford
Latitude 36.1865
Longitude-79.7058
Date COC Issued * 08/16/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* • Legally Responsible Individual Only
Site Contact Only
BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? U No
Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 973-765-0100 x4063
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Dan Lacz
Individual (Previous)
First Name (New)* Holden
Last Name (New) * Sabato

NEW Legally Reflects any revisions above
Responsible Holden Sabato
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone] x4063
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 195 Morristown Road, 0, Basking Ridge, NJ
Address (Previous) 07920
NEW Permittee Street Address
Mailing Address* 195 Morristown Road
Address Line 2
City
State / Province / Region
Basking Ridge
NJ
Postal / Zip Code
Country
07920
USA
Permittee Street 195 Morristown Road, 0, Basking Ridge, NJ
Address (Previous) 07920
NEW Permittee Street Street Address
Address* 195 Morristown Road
Address Line 2
City
State / Province / Region
Basking Ridge
NJ
Postal / Zip Code
Country
07920
USA
Change Requested Jimmy Constantakis and Doug Keesee via Modification request follow-up emails on
by: * 1/28/2022 and 2/3/2022.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Prior legally responsible person is no longer with the company.
(Optional)
Date * 02/04/2022