NCC202867_Contact Update Record_20231004

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 10/4/2023 11:38:48 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC202867
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-2867
Original NOI No.* 27926
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Grifols Theraputics
Project Name Grifols-The PLC Expansion
Address 9142 US HWY 70 BUS,Clayton, NC
County Johnston
Latitude 35.6254
Longitude -78.4214
Date COC Issued* 08/20/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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? 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 Donald Parker
Individual(Previous)
First Name(New)* David
Last Name(New)* Auge

NEW Legally Reflects any revisions above
Responsible David Auge
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 8368 Us 70 Bus Hwy W, 0, Clayton, NC
Address(Previous) 27520
NEW Permittee Street Address
Mailing Address* 8368 Us 70 Bus Hwy W
Address Line 2
City State/Province/Region
Clayton NC
Postal/Zip Code Country
27520 Us
Permittee Street 8368 Us 70 Bus Hwy W, 0, Clayton, NC
Address(Previous) 27520
NEW Permittee Street Street Address
Address* 8368 Us 70 Bus Hwy W
Address Line 2
City State/Province/Region
Clayton NC
Postal/Zip Code Country
27520 Us
Change Requested David Auge via Modification request submitted 9/26/2023.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 10/04/2023