NCC204023_Contact Update Record_20211018

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 10/18/2021 3:54:01 PM (Contact Changes Submitted)

Certificate of NCC204023
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-4023
Original NOI No.* 31318
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
VICTORI CONSTRUCTION LLC
Project Name Trinity Express Oil
Address 8128 Market St, Wilmington, NC
County New Hanover
Latitude 34.2959
Longitude-77.7928
Date COC Issued * 09/15/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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? • No
Yes
Billing Email
Billing Telephone No.
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible
TORI JAHN
Individual (Previous)
First Name (New) *
TORI
Last Name (New)*
JAHN
NEW Legally
Reflects any revisions above
Responsible
TORI JAHN
Individual*

Permittee Email
[e-mail]
(Previous)
NEW Permittee
[e-mail]
Email*
Permittee Telephone
9802249964
No. (Previous)
NEW Permittee
704-441-8625
Telephone No.*
Permittee Mailing
1708 Thomas Avenue, 0, Charlotte, NC
Address (Previous)
28205
NEW Permittee
Street Address
Mailing Address*
1708 Thomas Avenue
Address Line 2
City
Charlotte
Postal / Zip Code
28205
Permittee Street
1708 Thomas Avenue, 0, Charlotte, NC
Address (Previous)
28205
NEW Permittee Street
Street Address
Address*
1708 Thomas Avenue
Address Line 2
State / Province / Region
NC
Country
United States
City State / Province / Region
Charlotte NC
Postal / Zip Code Country
28205 United States
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact
TORI JAHN
(Previous)
Site Contact Title
President
(Previous)
Organization
VICTORI CONSTRUCTION LLC
(Previous)
First Name (New)*
TORI
Last Name (New)*
JAHN
NEW Site Contact*
Reflects any revisions above
TORI JAHN
NEW Site Contact
President
Title
NEW Organization
VICTORI CONSTRUCTION LLC
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 9802249964
Telephone No.
(Previous)
NEW Site Contact 704-441-8625
Telephone No.*
Site Contact Mailing 1708 Thomas Ave, 0, Charlotte, NC 28205
Address (Previous)
NEW Site Contact Street Address
Mailing Address* 1708 Thomas Ave
Address Line 2
City
Charlotte
Postal / Zip Code
28205
State / Province / Region
NC
Country
United States
Change Requested Tori S. Jahn by email on 10/18/2021
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 10/18/2021