NCC191826_Contact Update Record (Legally Resp Change)_20221025

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 10/25/2022 10:42:08 AM (Contact Changes Submitted)

Certificate of NCC191826
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2019-1826
Original NOI No.* 15791
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Public Service Company of North Carolina
Project Name New Hill (62068) High Pressure Main Laydown Yard
Address 5944 Lower Moncure Road, Deep River Township, NC
County Lee
Latitude 35.6090
Longitude-79.0920
Date COC Issued * 10/25/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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 800 Gaston Road, Building A, 0, Gastonia,
Address (Previous) North Carolina 28056
NEW Permittee Street Address
Mailing Address* P.O. Box 1398
Address Line 2
City
State / Province / Region
Gastonia
North Carolina
Postal / Zip Code
Country
28053
United States
Permittee Street 800 Gaston Road, Building A, 0, Gastonia,
Address (Previous) North Carolina 28056
NEW Permittee Street Street Address
Address* 800 Gaston Road
Address Line 2
Building A
City
State / Province / Region
Gastonia
North Carolina
Postal / Zip Code
Country
28056
United States
Change Requested Andrew Moore (Director - Engineering & Construction) via Modification request
by: * submitted 10/20/2022.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 10/25/2022