NCC221158_Contact Update Record_20231023

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Tev.Holloman 10/23/2023 2:41:28 PM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC221158
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-1158
Original NOI No.* 84601
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
MCB Camp Lejeune
Project Name MCAS-2 Automotive Organizational Shop(P685)
Address Perimeter Road,Camp Lejeune, NC
County Onslow
Latitude 34.7023
Longitude -77.4392
Date COC Issued* 03/25/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
0 Yes
Billing Email [e-mail]
Billing Telephone No. 9104513238 ext.3242
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Bobby Walton
(Previous)
Site Contact Title Supt/QCM/SSHO
(Previous)
Organization Military&Federal Construction
(Previous)
First Name(New)* Bobby

Last Name(New)* Walton
NEW Site Contact* Reflects any revisions above
Bobby Walton
NEW Site Contact Supt/QCM/SSHO
Title
NEW Organization Military&Federal Construction
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 9105461946
Telephone No.
(Previous)
NEW Site Contact 9105461946
Telephone No.*
Site Contact Mailing 846 Bell Fork Road,0,Jacksonville, NC
Address(Previous) 28540-6312
NEW Site Contact Street Address
Mailing Address* 846 Bell Fork Road
Address Line 2
City State/Province/Region
Jacksonville NC
Postal/Zip Code Country
28540-6312 us
Change Requested Betty White,Office Manager via email on 10/23/2023
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 10/23/2023