NCC221882_Contact Update Record (Name Correction)_20240507

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/7/2024 10:16:57 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC221882
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-1882
Original NOI No.* 91274
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Duke Energy Carolinas,LLC
Project Name Marshall CAMA CAP Well Installation-Phase II (Express Review)
Address 8320 NC 150,Sherrils Ford, NC
County Catawba
Latitude 35.5969
Longitude -80.9663
Date COC Issued* 04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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? 0• No
0 Yes
Billing Email [e-mail]
Billing Telephone No. [phone]
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible David Dellario
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 410 S.Wilmington Street,0, Raleigh, NC
Address(Previous) 27601
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 410 S.Wilmington Street,0, Raleigh, NC
Address(Previous) 27601
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 J.Zarzar via Modification request submitted 5/3/2024(Name correction only to
by:* entry from earlier today).
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/07/2024