NCC190952_Contact Update Record (Legally Resp Change)_20220627

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 6/27/2022 9:44:16 PM (Contact Changes Submitted)

Certificate of NCC190952
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2019-0952
Original NOI No.* 13436
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Public Service Company of North Carolina, Inc.
Project Name New Hill (62068) High Pressure Main
Address New Hill Olive CHapel Road, Apex, NC
County Wake
Latitude 35.7050
Longitude-78.9420
Date COC Issued * 07/15/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Shaun Randall
Individual (Previous)
First Name (New)* Andrew
Last Name (New) * Moore

NEW Legally Reflects any revisions above
Responsible Andrew Moore
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing PO Box 1398, 0, Gastonia, NC 28056
Address (Previous)
NEW Permittee Street Address
Mailing Address* 800 Gaston Road
Address Line 2
MC N05
City
State / Province / Region
Gastonia
NC
Postal / Zip Code
Country
28056
United States
Permittee Street 800 Gaston Road, Building A, Gastonia, NC
Address (Previous) 28056
NEW Permittee Street Street Address
Address* 800 Gaston Road
Address Line 2
MC N05
City
State / Province / Region
Gastonia
NC
Postal / Zip Code
Country
28056
US
Change Requested Andrew Moore via Modification request submitted 6/22/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 06/27/2022