NCC204276_Contact Update Record (Legally Resp)_20220310

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 3/10/2022 3:19:28 PM (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 36.1050
Longitude-78.8400
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Prior Rescission Date This field will populate only if COC has already been rescinded.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? U No
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Peter Greaves
Individual (Previous)
First Name (New)* Sean
Last Name (New)* Montague

NEW Legally Reflects any revisions above
Responsible Sean Montague
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 5235 Old Oxford Road, 0, Durham, NC 27712
Address (Previous)
NEW Permittee Street Address
Mailing Address* 5235 Old Oxford Road
Address Line 2
City
State / Province / Region
Durham
NC
Postal / Zip Code
Country
27712
us
Permittee Street 5235 Old Oxford Road, 0, Durham, NC 27712
Address (Previous)
NEW Permittee Street Street Address
Address* 5235 Old Oxford Road
Address Line 2
City State / Province / Region
Durham NC
Postal / Zip Code Country
27712 us
Change Requested Sean Montague (Director - Global Engineering Solutions) via Modification request
by: * submitted 3/7/2022.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 03/10/2022