NCC214571_Contact Update Record (Site Contact Update)_20220204

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 2/4/2022 2:48:31 PM (Contact Changes Submitted)

Certificate of
NCC214571
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2021-4571
Original NOI No.*
61840
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
SL Reedy Fork LLC
Project Name Reedy Fork Industrial
Address 5955 Summit Avenue, Greensboro, NC
County Guilford
Latitude 36.1865
Longitude-79.7058
Date COC Issued * 08/16/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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 [e-mail]
Billing Telephone No. [phone]
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Doug Keesee
(Previous)
Site Contact Title Senior Project Manager
(Previous)
Organization Intercon
(Previous)
First Name (New)* Doug

Last Name (New) * Keesee
NEW Site Contact* Reflects any revisions above
Doug Keesee
NEW Site Contact Senior Project Manager
Title
NEW Organization SL Management Group SE
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 980-216-0538
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing PO Box 34443, 0, Charlotte, NC 28234
Address (Previous)
NEW Site Contact Street Address
Mailing Address* 550 S Caldwell Street
Address Line 2
Suite 725
City
State / Province / Region
Charlotte
NC
Postal / Zip Code
Country
28202
USA
Change Requested Doug Keesee (to update affiliation information)
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 02/04/2022