NCC205628_Contact Update Record_20230103

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 1/3/2023 7:59:47 PM (Contact Changes Submitted)

Certificate of NCC205628
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-5628
Original NOI No.* 37771
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Caswell Properties, LLC
Project Name Carolina Sunrock LLC - Burlington North
Address 12971 NC Hwy 62, Burlington, NC
County Caswell
Latitude 36.2480
Longitude-79.3280
Date COC Issued * 12/08/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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 Gregg Bowler
Individual (Previous)
First Name (New)* Terry
Last Name (New) * Manis

NEW Legally Reflects any revisions above
Responsible Terry Manis
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 200 Horizon Drive, Suite 100, Raleigh, NC
Address (Previous) 27615
NEW Permittee Street Address
Mailing Address* 200 Horizon Drive
Address Line 2
Suite 100
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27615
USA
Permittee Street 200 Horizon Drive, Suite 100, Raleigh, NC
Address (Previous) 27615
NEW Permittee Street Street Address
Address* 200 Horizon Drive
Address Line 2
Suite 100
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27615
USA
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Scott Martino
(Previous)
Site Contact Title Environmental Compliance Manager / Mine Engineer
(Previous)
Organization Carolina Sunrock LLC
(Previous)
First Name (New)* Tracy
Last Name (New) * Davis

NEW Site Contact* Reflects any revisions above
Tracy Davis
NEW Site Contact Environmental Compliance Manager / Mine Engineer
Title
NEW Organization Carolina Sunrock LLC
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 9197476336
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 200 Horizon Drive, Suite 100, Raleigh, NC
Address (Previous) 27615
NEW Site Contact Street Address
Mailing Address* 200 Horizon Drive
Address Line 2
Suite 100
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27615
USA
Change Requested Scott Martino via e-mail on 1/3/2023.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 01 /03/2023