NCC205268_Contact Update Record_20231208

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 12/8/2023 9:33:15 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC205268
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-5268
Original NOI No.* 36361
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
MA Shelby,LLC
Project Name AMES Copper Smelting Plant
Address Old Boiling Springs Road,Shelby, NC
County Cleveland
Latitude 35.2912
Longitude -81.5853
Date COC Issued* 11/18/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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
4) 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 Claude Dube
Individual(Previous)
First Name(New)* Dayne
Last Name(New)* Willis

NEW Legally Reflects any revisions above
Responsible Dayne Willis
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 135 Old Boiling Springs Road,0, Shelby, NC
Address(Previous) 28152
NEW Permittee Street Address
Mailing Address* 125 Old Boiling Springs Road
Address Line 2
City State/Province/Region
Shelby NC
Postal/Zip Code Country
28152 USA
Permittee Street 135 Old Boiling Springs Road,0, Shelby, NC
Address(Previous) 28152
NEW Permittee Street Street Address
Address* 125 Old Boiling Springs Road
Address Line 2
City State/Province/Region
Shelby NC
Postal/Zip Code Country
28152 USA
Change Requested Dayne Willis(General Manager)via email on 12/6/2024
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 12/08/2023