NCC204276_Contact Update Record (Site Contact)_20211123

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 11/23/2021 8:57:14 AM (Contact Changes Submitted)

Certificate of
NCC204276
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2020-4276
Original NOI No.*
31987
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new COC required)
Merck Sharp & Dohme Corp.
Project Name
Project Flash - Mass Grading
Address
5325 Old Oxford Road, Durham, NC
County
Durham
Latitude
36.0000
Longitude
-79.0000
Date COC Issued *
10/02/2020
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This field will populate only if COC has already been rescinded.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.
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Peter Greaves
(Previous)
Site Contact Title Project Manager
(Previous)
Organization Merck Sharp & Dohme Corp.
(Previous)
First Name (New)* Kevin

Last Name (New) * Braziel
NEW Site Contact* Reflects any revisions above
Kevin Braziel
NEW Site Contact Project Manager
Title
NEW Organization Merck Sharp & Dohme Corp.
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 919-421-2790
Telephone No.
(Previous)
NEW Site Contact 305-219-0587
Telephone No.*
Site Contact Mailing 5235 Old Oxford Road, 0, Durham, NC 27712
Address (Previous)
NEW Site Contact Street Address
Mailing Address* 5325 Old Oxford Road
Address Line 2
City
State / Province / Region
Durham
NC
Postal / Zip Code
Country
27712
us
Change Requested Connor Jones by email on 11/22/2021
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 11 /23/2021