NCC202708_Contact Update Record (Name Correction)_20240507

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/7/2024 9:01:42 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC202708
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-2708
Original NOI No.* 27414
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Duke Energy Carolinas,LLC
Project Name Marshall CAMA CAP Pilot Well Installation
Address 8202 E. Highway 150,Sherrils Ford, NC
County Catawba
Latitude 35.5966
Longitude -80.9718
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Prior Rescission Date This field will populate only if COC has already been rescinded.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? 0• No
0 Yes
Billing Email [e-mail]
Billing Telephone No. [phone]
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Issa J. Issa J.Zarzar
Individual(Previous)
First Name(New)* Issa J.
Last Name(New)* Zarzar
NEW Legally Reflects any revisions above
Responsible Issa J.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 S.Wilmington Street,0, Raleigh, NC
Address(Previous) 27601
NEW Permittee Street Address
Mailing Address* 410 S.Wilmington Street
Address Line 2
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27601 us
Permittee Street 410 S.Wilmington Street,0, Raleigh, NC
Address(Previous) 27601
NEW Permittee Street Street Address
Address* 410 S.Wilmington Street
Address Line 2
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27601 us
Change Requested Issa J.Zarzar via Modification request submitted 5/3/2024(Just a correction to
*by: legally responsible name entry completed earlier today).
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/07/2024