NCC230837_Contact Update Record (Site Contact)_20240306

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 3/6/2024 3:40:06 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC230837
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-0837
Original NOI No.* 133124
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Premix Apple Creek Property,LLC
Project Name Premix-Apple Creek Corporate Park
Address 5119 Apple Creek Parkway, Dallas, NC
County Gaston
Latitude 35.3100
Longitude -81.2230
Date COC Issued* 03/29/2023
Prior Rescission Date This field will populate only if COC has already been rescinded.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. 980-320-7294
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Thomas Dryman
(Previous)
Site Contact Title Site Construction Manager/Plant GM
(Previous)
Organization Premix Group, North Carolina, LLC
(Previous)
First Name(New)* Ryan

Last Name(New)* Kilkelly
NEW Site Contact* Reflects any revisions above
Ryan Kilkelly
NEW Site Contact Plant Operations Manager
Title
NEW Organization Premix Group, North Carolina, 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 864-567-2686
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 52A Ervin Street, 0, Belmont, NC 28012-3327
Address(Previous)
NEW Site Contact Street Address
Mailing Address* 52A Ervin Street
Address Line 2
City State/Province/Region
Belmont NC
Postal/Zip Code Country
28012-3327 us
Change Requested Jari-Matti Mehto via email on 3/2/2024(additional contact info by follow-up email
by:* from Ryan Kilkelly on 3/6).
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 03/06/2024