NCC215050_Contact Update Record_20240105

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 1/5/2024 9:20:38 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC215050
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-5050
Original NOI No.* 64246
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Duke Energy Progress LLC
Project Name Mayo Monofill Borrow Area
Address HWY 501, Roxboro, NC
County Person
Latitude 36.5292
Longitude -78.9267
Date COC Issued* 09/08/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 13363302058
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Duncan Brewer
Individual(Previous)
First Name(New)* Issa J.
Last Name(New)* Zarzar

NEW Legally Reflects any revisions above
Responsible Issa J.Zarzar
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 10660 Boston Road,0, Roxboro, NC 27574
Address(Previous)
NEW Permittee Street Address
Mailing Address* 410 S.Wilmington Street
Address Line 2
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27601 us
Permittee Street 10660 Boston Road,0, Roxboro, NC 27574
Address(Previous)
NEW Permittee Street Street Address
Address* 410 S.Wilmington Street
Address Line 2
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27601 us
Change Requested Issa Zarzar via Modification request submitted 1/2/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 01/05/2024