The URL can be used to link to this page

Home My WebLink About17424 XXX 101 03-01-2021 ORIG CJO 164588 SOLID WASTE DISPOSAL CERTIFICATION REVIEW FORM CERTIFICATION NUMBER: SW-033123-0007 WASTE PROFILE NUMBER: 164588 2021 ADEM STATUS DATE: 03/02/2021 GENERATOR NAME: ACHIEVA, INC EPAID: 2909 EAST SOUTH BLVD PHONE: MONTGOMERY,AL 36123 CONTACT: DATE RECEIVED: 03/01/2021 DATE REVIEWED: 03/02/2021 LANDFILL NAME: Salem Waste Disposal Center PERMIT NUMBER:41-03 LANDFILL NAME: North Montgomery MSWLF PERMIT NUMBER: 51-01 LANDFILL NAME: Stones Throw Disposal Center PERMIT NUMBER: 62-11 LANDFILL NAME: Timberlands SLF PERMIT NUMBER: 27-08 ASSIGNED PERSON: cjo Ms.Cale Obenauf WASTE NAME: GASOLINE IMPACTED MATERIALS FROM A UST FACILITY COUNTY: MONTGOMERY STATE: AL QUANTITY: 0.00 PER: FORM TYPE: O O= ORIGINAL R=RENEWAL FOUNDRY SAND: N STATUS CODE: (A) COMMENT: MONTGOMERY CO IS WITHIN THE SERVICE AREA OF ALL 4 LF LISTED UST FACILITY ID 22142-101-011498 INCIDENT#UST211204 EMAIL MATT EBBERT 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 COBENAUF 03/02/2021 10:19 am 1 From: Ebbert,Matt TO: Land Waste Anoroval Applications Subject: Request for Waste Profile No.-Former Quick Serve No.25-Montgomery,AL Date: Monday,March 1,2021 5:07:12 PM Altachmepta: Form300-Former Ouirk Serve No,2L= 403602-ADEM General Invoice rumments-Receiobodf Good evening. Attached are a waste profile form and proof of payment of the ADEM fee for soil from a release of unleaded gasoline from a UST facility. Please let me know if you need anything else. Thanks Matthew J. Ebbert, P.G. Senior Geologist PPM Consultants, Inc. 5555 Bankhead Highway Birmingham, AL 35210 p: 205-836-5650 m: 205-919-0169 matt ebbertCD_ppmco com wkvw.gomco.co I Alabama Department of Environmental Management Solid Waste Profile Sheet Form 300 General Information Profile Type(check one): ❑� New Certification ❑Recertification ❑Modification to Active Profile Generator Name: Achieva, Inc. Generator Physical Address: 2909 East South Boulevard Generator County: Montgomery EPAID: NA Generator Mailing Address: P.O. Box 230963. Montgomery. AL 36123-0963 Generator Contact: Mr. Mashud Reza Title: Owner Phone: 334-221-3055 Email: mashudreza@gmail. com Submitted by(if different from above): Company Name: RPM Consultants, Inc. Contact: Matt Ebbert Mailing Address: 5555 Bankhead Highway, Birmingham, AL 35210 Phone: 205-836-5650 Email: matt.ebbert@ppmco. com Waste Information Process Generating Gasoline-impacted soil, PVC, and concrete from remediation of an Waste: unleaded gasoline release at an underground storage tank facility. Work is reviewed by the ADEM UST Corrective Action Unit. Waste Name: Gasoline-impacted materials from a UST facilitv If this waste is subject to Corrective Action regulations 40 CFR Part 280(UST)provide the following information: UST Facility to# 22142-101-011498 UST Incident# UST21-12-04 Source of Petroleum Contamination(Gas, Diesel,Used Oil, Hydraulic Oil,act.): unleaded gasoline Does the waste contain any of the following: ❑PCBs El Cyanides ❑Sulfides ❑Asbestos Concentration: Units: ❑mg/L ❑mg/Kg ❑PPM ❑PPB Waste Type: ❑Remediation ❑Process ❑CERCLA Cleanup ❑Other Waste Volume: 1, 700 Units: tons Frequency: ❑Annual [I Quarterly ❑Monthly Waste Properties Physical State: ❑Solid []Liquid ❑Bladeable Sludge ❑Solid/Liquid Combination ❑Other %Free Liquids 0 pH(if liquid) Flash Point(if liquid) Will liquids be solidified prior to disposal(see instructions)? DYES ❑� NO Waste Disposition Is this Foundry Waste handled in accordance to ADEM Code 335-13A-.26(3)? []YES NO Is this Wood Ash handled in accordance to ADEM Code 335-134-.26(6)? DYES Q NO Landfill Name#1: Salem Waste Center Permit#: 4103 Landfill Name#2: North Montgomery Landfill Permit#: 51-01 Landfill Name#3: Stones Throw Disposal Center permit#: 62-11 Landfill Name#4: Timberlands Landfill permit#: 27-08 Current Profile No. (if applicable) ADEM Form 300 10/17 m2 Page 1 of 2 Alabama Department of Environmental Management Solid Waste Profile Sheet Form 300 Continuation Form Process Generating Waste continued: Other: Certifimtlon 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. Matthew J. Ebbert, on Achieva. Inc. Sr. Geologist Name(type ,or prinntt))L p Title Februarv26. 2O21 Signature Dale ADEM Form 300 10/17 m2 Page 2 of 2 3i 1/2021 ADEM General Invoice payments-Receipt ALABAMA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT (334) 271-7700 1400 Coliseum Blvd. Montgomery, AL 36110 mailing address: Post Office Box 301463, Montgomery, AL 36130-1463 Recelpt Confirmation Page ADEM requires that when you pay online,you MUST print out the confirmation information and submit it as proof of payment with your permit application or any other correspondence requiring proof of payment. Payment Summa Pgmar hem Fae Online Payment-03I012021 15:3102 $215 Q0 Total Fee through AlaWma.gov U {217.00 Receipt Confirmation Number:20210301000023062 General Invoice Information Choose the type of payment you are making:5311-LAND-SOLID WASTE APPROVAL FEE Description of Other Fees: Additional Information/Fee Description:ACHIEVA-FORMER QUICK SERVE 25-FAC 22142-101-0114%-UST21-12M-RPM 403602-PI Number o0 your ADEM Invoice: Date on your ADEM invoice: Contact Information Company/Facility or Individual Name:RPM CONSULTANTS INC. Facility Permit Number(if applicable): Company or Facility Phone:205 836-5650 Contact Person:MATT EBBERT Contact Phone:205-909-1451 Contact email address:Iesae hunt@ppmw.com Name of an ADEM Program Staff Member(if known): Policy Related Questions:334 271-7700 Applicetian Supper 866353 M68 or drpp eebemenc wcaiq Vernon 2.0.0 hnps://www.alabamaintemcbv .org/adem_genemi payments/echecknotion ili