NCC192201_Contact Update Record (Legally Resp Change)_20220627

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 6/27/2022 9:27:53 PM (Contact Changes Submitted)

Certificate of
NCC192201
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2019-2201
Original NOI No.*
16740
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Dominion Energy North Carolina
Project Name Cole Mill Road Gas Pipeline Extension
Address Cole Mill Road and Umstead Road, Eno Township, NC
County Orange
Latitude 36.0670
Longitude-78.9860
Date COC Issued* 11/25/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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 Shaun Randall
Individual (Previous)
First Name (New)* Andrew
Last Name (New) * Moore

NEW Legally Reflects any revisions above
Responsible Andrew Moore
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing PO Box 1398, 0, Gastonia, NC 29056
Address (Previous)
NEW Permittee Street Address
Mailing Address* 800 Gaston Road
Address Line 2
MC N05
City
State / Province / Region
Gastonia
NC
Postal / Zip Code
Country
29056
United States
Permittee Street 800 Gaston Road, Building A, Gastonia,
Address (Previous) Gastonia 29056
NEW Permittee Street Street Address
Address* 800 Gaston Road
Address Line 2
MC N05
City
State / Province / Region
Gastonia
Gastonia
Postal / Zip Code
Country
29056
United States
Change Requested Andrew Moore via Modification request submitted 6/22/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 06/27/2022