NCC221230_Contact Update Record (Leg Resp Change)_20220819

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 8/19/2022 10:03:42 AM (Contact Changes Submitted)

Certificate of NCC221230
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2022-1230
Original NOI No.* 85077
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Piedmont Natural Gas Company, Inc.
Project Name PNG Line 142 Buffalo Road Main Extension
Address Covered Bridge Road, Archer Lodge, NC
County Johnston
Latitude 35.6920
Longitude-78.3730
Date COC Issued * 04/04/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.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? U No
Yes
Billing Email
[e-mail]
NEW Billing Email
[e-mail]
Billing Telephone No.
252.722.1792
NEW Billing
[phone]
Telephone No.
(Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Jeremy Meads
Individual (Previous)
First Name (New)* Jeremy
Last Name (New) * Koster

NEW Legally Reflects any revisions above
Responsible Jeremy Koster
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 105 Impact Boulevard, 0, Elizabeth City, NC
Address (Previous) 27907
NEW Permittee Street Address
Mailing Address* 250 Five Points Road
Address Line 2
City
State / Province / Region
Dudley
NC
Postal / Zip Code
Country
28333
us
Permittee Street 105 Impact Boulevard, 0, Elizabeth City, NC
Address (Previous) 27907
NEW Permittee Street Street Address
Address* 250 Five Points Road
Address Line 2
City State / Province / Region
Dudley NC
Postal / Zip Code Country
28333 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Jeremy Meads
(Previous)
Site Contact Title Sr. Distribution Project Specialist
(Previous)
Organization Piedmont Natural Gas Company, Inc.
(Previous)
First Name (New)* Jeremy
Last Name (New) * Koster
NEW Site Contact* Reflects any revisions above
Jeremy Koster

NEW Site Contact VP Strategic Operations
Title
NEW Organization Piedmont Natural Gas Company, Inc.
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 252.722.1792
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 105 Impact Boulevard, 0, Elizabeth City, NC
Address (Previous) 27907
NEW Site Contact Street Address
Mailing Address* 250 Five Points Road
Address Line 2
City State / Province / Region
Dudley NC
Postal / Zip Code Country
28333 us
Change Requested Jeremy Koster via Modification request submitted 8/16/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Site contact was also listed as previous responsible individual, so it was updated to
(Optional) Jeremy Koster as well.
Date * 08/19/2022