NCC221159_Contact Update Record_20230322

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by bethany.georgoulias 3/22/2023 3:06:06 PM (Contact Changes Submitted)

Certificate of
NCC221159
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2022-1159
Original NOI No.*
84603
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new COC required)
MCB Camp Lejeune
Project Name
2D 8th ESB Headquarters (P1524) - EXPRESS
Address
Reasoner Street, Camp Lejeune, NC
County
Onslow
Latitude
34.6452
Longitude
-77.3348
Date COC Issued *
03/28/2022
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This field will populate only if COC has already been rescinded.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?
Q No
Yes
Billing Email
[e-mail]
Billing Telephone No.
510-828-1131
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact
Darren McGill
(Previous)
Site Contact Title
Superintendent
(Previous)
Organization
RQ Construction
(Previous)
First Name (New)*
Ryan

Last Name (New)* Smith
NEW Site Contact* Reflects any revisions above
Ryan Smith
NEW Site Contact Sr Project Engineer
Title
NEW Organization RQ Construction
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 910-530-2767
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing CTR 133 Julian C. Smith St., 0, Camp
Address (Previous) Lejeune, NC 28547
NEW Site Contact Street Address
Mailing Address* CTR 133 Julian C. Smith St.
Address Line 2
City
State / Province / Region
Camp Lejeune
NC
Postal / Zip Code
Country
28547
us
Change Requested Talia Prendergast via Modification request submitted 3/20/2023 and additional email
by: * details from Ryan Smith on 3/21/2023.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 03/22/2023