NCC190542_Contact Update Record_20230524

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/24/2023 8:01:41 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC190542
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2019-0542
Original NOI No.* 11876
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Dominion Energy
Project Name Dominion Energy-M-64 Natural Gas Pipeline(Phase 2C)
Address Hudlow Rd, U.S.221, Old U.S.221,Glenwood, NC
County Rutherford
Latitude 35.6140
Longitude -81.9819
Date COC Issued* 06/07/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q 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,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 us
Permittee Street 800 Gaston Road,0,Gastonia, NC 28056
Address(Previous)
NEW Permittee Street Street Address
Address* 800 Gaston Road
Address Line 2
City State/Province/Region
Gastonia NC
Postal/Zip Code Country
28056 us
Change Requested Andrew Moore via Modification request submitted 5/19/2023.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/24/2023