NCC203572_Contact Update Record (Leg Resp Change)_20220812

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 8/12/2022 12:23:06 PM (Contact Changes Submitted)

Certificate of NCC203572
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-3572
Original NOI No.* 29912
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Public Services Company of North Carolina, Inc.
Project Name Johnson Pond Road Gas Pipeline Extension
Address Johnson Pond Road, Middle Creek Township, NC
County Wake
Latitude 35.6430
Longitude-78.7420
Date COC Issued * 08/18/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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 M. 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 P.O. Box 1398, 0, Gastonia, NC 28056
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
28056
us
Permittee Street 800 Gaston Road, Building A, Gastonia, NC
Address (Previous) 28056
NEW Permittee Street Street Address
Address* 800 Gaston Road
Address Line 2
MC N05
City
State / Province / Region
Gastonia
NC
Postal / Zip Code
Country
28056
us
Change Requested Andrew Moore via Modification request submitted 7/18/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 08/12/2022