NCG510070_Report_20240802

North Carolina Department of Environmental Quality
Division of Water Resources
Permit Number: NCG510070
Permit Type: Groundwater Remediation Wastewater Discharge COC
Facility Name: Dixie Grocery
Facility Addressl: 4730 NC Hwy 39 S
Facility Address2:
City, State & Zip: Henderson. NC 2753
Owner Information Details:
MUST submit a Change ofNamejOwnership form to DWR to make any changes to this Owner information.
(Click HAM for "Change ofNa =62lW ffi 9-E90)
Owner Name: Dixie Grocery Inc
Owner Type: Non -Government
Owner Type Group: Organization
* * * Legally Responsible for Permit * * *
(Responsible corporate officer/prindple executive officer or ranking elected offldal/general partner or proprietor;
or any other person with delegated signatory authority from the legally rexponsible person.)
Owner Affiliation: Dennis Poythress Title:
Addressl: 4365 NC Hwy 39 S
Address2:
City, State & Zip: Henderson -NC 27536
Work Phone: [phone] Fax:
Email Address:
Owner Contact Person(s)
Contact Name Tag Address Phone( Email
Facility Contact`Person(s)
Contact Name Title Addoes Phone Fax Email
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
Permit Billing Contact Person(s)
Contact Name Title Address Phone Fax Email
Dennis Poythress 4365 NC Hwy 39 S, Henderson, NC 252-213-0016
Pers6ns with Signatory- Authority
Type Contact Name Title Address Phone Fax Email
Owner lames Dodson C 914-1596-9494, 944-SeemoV8
NC
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7/ 29/ 2024 Page 1