NCC202786_Contact Update Record_20210706

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 7/6/2021 2:32:30 PM (Contact Changes Submitted)

Certificate of NCC202786
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-2786
Original NOI No.* 27696
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
Duke Energy Carolinas, LLC
Project Name
Allen CAMA CAP Pilot Well Installation
Address
253 Plant Allen Road, Belmont, NC
County
Gaston
Latitude
35.1860
Longitude
-81.0180
Date COC Issued*
07/10/2020
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
F Legally Responsible Individual Only
f Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'torevise Billing Contact details.
Changed?
r No
r Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone
No.
NEW Billing [phone]
Telephone No. (Cptional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Scott Martin
Individual
(Previous)

First Name (New)*
Mehdi
Last Name (New) *
Maibodi
NEW Legally
Peflects any revisions above
Responsible
Mehdi Maibodi
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 704-913-1623
Telephone No.
(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 400 South Tryon Street, ST 06K, Charlotte,
Address (Previous) NC 28202
NEW Permittee
Mailing Address*
Street Address
400 South Tryon Street
Address Line 2
Suite 30C
aty
Charlotte
Fbstal / Zip Code
28202
Permittee Street 400 South Tryon Street, ST 06K, Charlotte,
Address (Previous) NC 28202
NEW Permittee
Street Address*
Street Address
400 South Tryon Street
Address Line 2
Suite 30C
city
Charlotte
Fbstal / Zip Code
28202
State / Rovince / f;bgion
NC
Country
us
State / Rovince / Region
NC
Country
us
Change Requested Mehdi Maibodi via Modification request submitted 7/1/2021.
by: * Include any additional correspondence records in the Repository CDC folder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 07/06/2021