0001437749-23-012133.txt : 20230502 0001437749-23-012133.hdr.sgml : 20230502 20230502170331 ACCESSION NUMBER: 0001437749-23-012133 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20230502 DATE AS OF CHANGE: 20230502 EFFECTIVENESS DATE: 20230502 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Contamination Source Identification Inc. CENTRAL INDEX KEY: 0001788640 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-480621 FILM NUMBER: 23880240 BUSINESS ADDRESS: STREET 1: 326 DOGWOOD DRIVE CITY: HERSHEY STATE: PA ZIP: 17033 BUSINESS PHONE: 717-574-7083 MAIL ADDRESS: STREET 1: 326 DOGWOOD DRIVE CITY: HERSHEY STATE: PA ZIP: 17033 FORMER COMPANY: FORMER CONFORMED NAME: Contamination Source Identification LLC DATE OF NAME CHANGE: 20190918 D 1 primary_doc.xml X0708 D LIVE 0001788640 Contamination Source Identification Inc. 326 Dogwood Drive Hershey PA PENNSYLVANIA 17033 717-574-7083 DELAWARE None Contamination Source Identification LLC Corporation true 2018 Gary J. Shope 326 Dogwood Drive Hershey PA PENNSYLVANIA 17033 Executive Officer Director Promoter Gautem Patel 326 Dogwood Drive Hershey PA PENNSYLVANIA 17033 Director Randy Haluck 326 Dogwood Drive Hershey PA PENNSYLVANIA 17033 Director Tom Santone 326 Dogwood Drive Hershey PA PENNSYLVANIA 17033 Director Regina Lamendella 326 Dogwood Drive Hershey PA PENNSYLVANIA 17033 Executive Officer Justin Wright 326 Dogwood Drive Hershey PA PENNSYLVANIA 17033 Executive Officer Biotechnology Decline to Disclose 06b false 2023-04-19 false true true false 0 2500000 200000 2300000 false 2 0 0 0 false Contamination Source Identification Inc. /s/ Gary J. Shope Gary J. Shope Chief Executive Officer 2023-05-02