NCC204604_Contact Update Record (Legally Resp Change)_20221010

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 10/10/2022 8:39:37 AM (Contact Changes Submitted)

Certificate of NCC204604
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-4604
Original NOI No.* 32891
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Piedmont Natural Gas Co. Inc.
Project Name Fayetteville DOT Outer Loop Laydown Yard
Address Braddy Road, Fayetteville, NC
County Cumberland
Latitude 34.9889
Longitude-79.0395
Date COC Issued * 10/14/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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 Dave Vena
Individual (Previous)
First Name (New)* Joseph
Last Name (New) * Heckman

NEW Legally Reflects any revisions above
Responsible Joseph Heckman
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 33068, 0, Charlotte, NC 28210
Address (Previous)
NEW Permittee Street Address
Mailing Address* 4740 Corporation Drive
Address Line 2
City
State / Province / Region
Hope Mills
NC
Postal / Zip Code
Country
28306
US
Permittee Street 4720 Piedmont Row Drive, 0, Charlotte, NC
Address (Previous) 28210
NEW Permittee Street Street Address
Address* 4740 Corporation Drive
Address Line 2
City
State / Province / Region
Hope Mills
NC
Postal / Zip Code
Country
28306
USA
Change Requested Joseph Heckman (Project Manager) via Modification request submitted 10/3/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 10/10/2022