NCC203516_Contact Update Record_20240517

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/17/2024 8:44:01 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC203516
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-3516
Original NOI No.* 29866
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Duke Energy
Project Name Roxboro Borrow Stockpile Relocation
Address 1700 Dunnaway Road,Semora, NC
County Person
Latitude 36.4826
Longitude -79.0581
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Prior Rescission Date This field will populate only if COC has already been rescinded.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
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 Mehdi Maibodi
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 400 South Tryon Street,0, Charlotte, NC
Address(Previous) 28202
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 400 South Tryon Street,0, Charlotte, NC
Address(Previous) 28202
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 5/9/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/17/2024