NCC211421_Contact Update Record (Site Contact)_20241016

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 10/16/2024 4:24:54 PM(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Prior Rescission Date This field will populate only if COC has already been rescinded.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? 0• No
0 Yes
Billing Email [e-mail]
Billing Telephone No. [phone]
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Mike Kendrick
(Previous)
Site Contact Title Project Manager
(Previous)
Organization Duke Energy
(Previous)
First Name(New)* Justin

Last Name(New)* Melton
NEW Site Contact* Reflects any revisions above
Justin Melton
NEW Site Contact Project Manager II
Title
NEW Organization Duke Energy Progress 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 704-961-2248
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 10660 Boston Road,0, Roxboro, NC 27574
Address(Previous)
NEW Site Contact Street Address
Mailing Address* 10660 Boston Road
Address Line 2
City State/Province/Region
Roxboro NC
Postal/Zip Code Country
27574 United States
Change Requested Issa J.Zarzar via Modification request submitted 10/14/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 10/16/2024