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Home My WebLink About14861 XXX 127 12-10-2019 ORIG BLD 163730 SOLID WASTE DISPOSAL CERTIFICATION REVIEW FORM CERTIFICATION NUMBER: SW-123121-0032 WASTE PROFILE NUMBER: 163730 2020 ADEM STATUS DATE: 12/11/2019 GENERATOR NAME: JASPER OIL COMPANY/HANDY DANDY EPAID: 1385 ARKADELPHIA ROAD PHONE: JASPER,AL 35501 CONTACT: DATE RECEIVED: 12/10/2019 DATE REVIEWED: 12/11/2019 LANDFILL NAME: Jefferson County Landfill No. 1 PERMIT NUMBER: 37-43 LANDFILL NAME: Advanced Disposal Star Ridge Landfill PERMIT NUMBER: 58-05 LANDFILL NAME: Pineview Sanitary Landfill PERMIT NUMBER: 64-11 ASSIGNED PERSON: bid Bailee Dykes WASTE NAME: Petroleum Contaminated Soil(Gasoline) COUNTY: WALKER STATE: AL QUANTITY: 0.00 PER: FORM TYPE: O O= ORIGINAL R=RENEWAL FOUNDRY SAND: N STATUS CODE: (A) COMMENT: Walker County is within the service area of Jefferson County No. 1,Star Ridge,and Pineview -Fs. UST Facility ID#15532-127-013476 UST Incident#UST 01-01-10 Email approval letter to Bill Simmons. Non-contaminated(below lim) _Petro<or=100 ppm Petro> 100 ppm_Non-haz<50%TCLP_Non-haz>or=50%TCLP Date: Reviewed by: RESERVED I BDYKES 12/11/2019 8:34 am 1 From: all simmans TO: Land Waste Aoomval ApplIOtlons Subject Need Soild Waste Profile Approval Dale: Tuesday,December 10,2019 4:24:29 PM Attachment: iasoer oil handy dandy waste omfle aool m 56 odf Importance: High Waste, I am submitting a completed signed form 300 and proof of adem payment. Thanks Bill Simmons PRE, Inc. Alabama Department of Environmental Management Solid Waste Profile Sheet Form 300 General Information Profile Type(check one): ❑f New Certification El Recertification []Modification to Active Profile Generator Name: Jasper Oil Company/ Handy Dandy Generator Physical Address 1385 Arkadelphia Road, Jasper, Alabama Generator County: Walker EPA ID: N/A Generator Mailing Address: P.O. Box 1353, Jasper, AL 35501 Generator Contact: Bill Simmons Title: Vice President,PRE,Inc:Agent for Jasper oil Co.,Inc. Phone: 205-942-6293 Email: was@pre!ncorporated.com Submitted by(if different from above): Company Name: Contact: j Mailing Address: Phone: Email: Waste Information j Process Generating Invesigative Derived Waste(IDW) Waste: Waste Name: Petroleum Contaminated Soil If this waste is subject to Corrective Action regulations 40 CFR Part 280(UST)provide the following information: UST Facility ID If 15532-127-013476 UST Incident# UST01-01-10 Source of Petroleum Contamination(Gas, Diesel, Used Oil, Hydraulic Oil,etc.): Gasoline Does the waste contain any of the following: ❑PCBs []Cyanides []Sulfides ❑Asbestos Concentration: 0% Units: ❑mg/L ❑mg/Kg ❑PPM ❑PPB Waste Type: QRemediation ❑Process ❑CERCLA Cleanup []Other Waste Volume: 0.5 Units: Cubic Feet Frequency: Annual []Quarterly []Monthly Waste Properties Physical State: ❑Solid ❑Liquid ❑Bladeable Sludge ❑Solid/Liquid Combination ❑Other %Free Liquids 0% pH (if liquid) N/A Flash Point(if liquid) N/A Will liquids be solidified prior to disposal(see instructions)? ❑YES ❑ NO Waste Disposition Is this Foundry Waste handled in accordance to ADEM Code 335-13-4-.26(3)? ❑YES ❑ NO Is this Wood Ash handled in accordance to ADEM Code 335-134-.26(6)? ❑YES ❑ NO Landfill Name#1: Jefferson County Landfill Permit#: 37-43 Landfill Name#2: Star Ridge Landfill Permit#: 58-05 Landfill Name#3: Willow Ridge Landfill Permit If: 67-03 Landfill Name#4: Republic Services Pine View Sanitary Landfill permit#: 64-11 Current Profile No. (if applicable) ADEM Form 300 XX/18 mod3 Page 1 of 2 Alabama Department of Environmental Management Solid Waste Profile Sheet Form 300 Continuation Form Process Generating Waste continued: li Other: Certification I certify under penalty of law that this waste material does not contain regulated medical waste, regulated PCB waste, or hazardous waste which is not conditionally exempt from Division 14 Regulations. I further certify that,at the point of disposal, this waste material will not contain any free liquids.This document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true, accurate,and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. William A. Summons Vice Presicletlt,PRLz-Agent for Jasper UII (:0. Name(type v+ int Title 1Z/1U/ZU19 Signa Date I ADEM Form 300 XX/18 m3 Page 2 of 2 ADEM General Invoice payments -Receipt Page 1 of 1 ALABAMA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT (334)271-7700 1400 Coliseum Blvd. Montgomery,AL 36110 mailing address: Post Office Box 301463, Montgomery, AL 36130-1463 Receipt Confirmation Page ADEM requires that when you pay online,you MUST prim out the confbma0on Information and submit It as proof of paymenlwdlh your permit application or any other comeepondence requiring proof of payment. Payment Summary Ptymanl Item Fee OnWe Payment-1211.ol016.1Y05 $2170 rem,Fee hero..1,Alaeama see hoot $217.33 Receipt Confirmation Number:2D191210000020114 General Invoice Information Choose the type of payment you ere making.5311-LANd SOLID WASTE APPROVAL FEE Description of Other Fees:solid waste apaovadlee Additional lnformalloNFee Desorption'.solid waste approved fee Number on yow ADEM Invoice: 1142ans Dale onyour ADEMlnvoice'.12110/2019 Contact Information Company/Fadllty a IndbAduel Name:Jesper Oil CompanyHmWy,DeMy Facility Permit Number(if applicable):155R-127-013476 Company or Facility Phone: Contact Person:Bill Siemens Contact Phone:205942-e293 Contact email address'.wasItyprednrurpmetedeve Name of an ADEM Program Slag Member tit known):no 4, Pricy R111111 ouesllare'.3a417117to opplhsion euppoc 666-3533465 o, OoOn�aaasma08 e4ve verslonlssc i i https://www.alabamainteractive.org/adem_general_payments/cmditCard.action 12/10/2019