NCC211421_Contact Update Record_20240411

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 4/11/2024 7:41:58 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC211421
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-1421
Original NOI No.* 47461
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Duke Energy Progress, LLC
Project Name Mayo Ash Basin Landfill Erosion and Sediment Control
Address Boston Road, Roxboro, NC
County Person
Latitude 36.5260
Longitude -78.8970
Date COC Issued* 04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 336-330-2058
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Duncan Brewer
Individual(Previous)
First Name(New)* Issa
Last Name(New)* Zarzar

NEW Legally Reflects any revisions above
Responsible Issa Zarzar
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 410 South Wilmington Street,0, Raleigh, NC
Address(Previous) 2760 1-1 849
NEW Permittee Street Address
Mailing Address* 410 South Wilmington Street
Address Line 2
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27601-1849 us
Permittee Street 410 South Wilmington Street,0, Raleigh, NC
Address(Previous) 2760 1-1 849
NEW Permittee Street Street Address
Address* 410 South Wilmington Street
Address Line 2
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27601-1849 us
Change Requested Issa Zarzar via Modification request submitted 4/10/2024
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 04/11/2024