NCC231640_Contact Update Record (LEG RESP CHANGE)_20240702

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 7/2/2024 12:27:31 PM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC231640
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-1640
Original NOI No.* 142701
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
City of Washington
Project Name Washington-Warren Airport,Airfield Drainage Improvements
Address 200 Airport Road,Washington, NC
County Beaufort
Latitude 35.5712
Longitude -77.0467
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Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
(6) Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 252-946-3900
NEW Billing [phone]
Telephone No. (optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Earl Malpass
Individual(Previous)
First Name(New)* Joshua J.
Last Name(New)* Waters

NEW Legally Reflects any revisions above
Responsible Joshua J.Waters
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 200 Airport Road,0,Washington, NC 27889
Address(Previous)
NEW Permittee Street Address
Mailing Address* 200 Airport Road
Address Line 2
City State/Province/Region
Washington NC
Postal/Zip Code Country
27889 us
Permittee Street 200 Airport Road,0,Washington, NC 27889
Address(Previous)
NEW Permittee Street Street Address
Address* 200 Airport Road
Address Line 2
City State/Province/Region
Washington NC
Postal/Zip Code Country
27889 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Earl Malpass
(Previous)
Site Contact Title Airport Manager
(Previous)
Organization City of Washington
(Previous)
First Name(New)* Joshua J.
Last Name(New)* Waters
NEW Site Contact* Reflects any revisions above
Joshua J.Waters

NEW Site Contact Operations Manager
Title
NEW Organization City of Washington
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 252-946-3900
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 200 Airport Road,0,Washington, NC 27889
Address(Previous)
NEW Site Contact Street Address
Mailing Address* 200 Airport Road
Address Line 2
City State/Province/Region
Washington NC
Postal/Zip Code Country
27889 us
Change Requested Joshua Waters(Interim Airport Manager)via Modification request submitted
by:* 6/26/2024.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 07/02/2024