NCC201074_Contact Update Record_20230427

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 4/27/2023 1:17:45 PM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC201074
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-1074
Original NOI No.* 23115
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Wyeth Holdings LLC
Project Name Pfizer Pharmaceuticals GTx2 Contractor Parking
Address Oak Park Road,Sanford, NC
County Lee
Latitude 35.5301
Longitude -79.1826
Date COC Issued* 03/19/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
C� 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 Tony Mulcahy
Individual(Previous)
First Name(New)* Jonathan
Last Name(New)* Tucker

NEW Legally Reflects any revisions above
Responsible Jonathan Tucker
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 4300 Oak Park Road, 0, Sanford, NC 27330
Address(Previous)
NEW Permittee Street Address
Mailing Address* 4300 Oak Park Road
Address Line 2
City State/Province/Region
Sanford NC
Postal/Zip Code Country
27330 us
Permittee Street 4300 Oak Park Road, 0, Sanford, NC 27330
Address(Previous)
NEW Permittee Street Street Address
Address* 4300 Oak Park Road
Address Line 2
City State/Province/Region
Sanford NC
Postal/Zip Code Country
27330 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Charles Powell
(Previous)
Site Contact Title EHS Manager
(Previous)
Organization Wyeth Holdings LLC
(Previous)
First Name(New)* Connor
Last Name(New)* Jarvis
NEW Site Contact* Reflects any revisions above
Connor Jarvis

NEW Site Contact
Title
NEW Organization Wyeth Holdings LLC
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 919-566-4018
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 4300 Oak Park Road, 0, Sanford, NC 27330
Address(Previous)
NEW Site Contact Street Address
Mailing Address* 4300 Oak Park Road
Address Line 2
City State/Province/Region
Sanford NC
Postal/Zip Code Country
27330 us
Change Requested Connor Jarvis via modification submitted 4/17/2023 and email follow-up on
by:* 4/27/2023.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 04/27/2023