HomeMy WebLinkAbout12724 009491 101 06-08-2021 CHIOWN LAH CHANGE IN OWNER 71920.32 r+UE4f
CHIOWN RECEIVED
ADEM O JUN 15 2021
UNDERGROUND AND ABOVEGROUND STORAGE TANK zo P
TRANSFER OF OWNERSHIP FORM %0 0Q-
Alabama Dept. of Environmental Management Phone # (334) 2705655
Groundwater Branch/Land Division Fax# (334) 270-5631
P. O. Box 301463 E-mail: ustcompliance@adem.alabama.gov
Montgomery, AL 36130-1463 Web Site: adem.alabama.gov
FACILITY INFORMATION
Former Name of Facility:United Food&Fuel#1 1 ADEM Fac lity I.D. Number: 12899 - 101 - 9491
Location street or highway): 4521 S.Court Street No. of USTs included in transfer:3
City, County: Montgomery,Montgomery I No. of ASTs included in transfer: 0
Transfer of Ownership Date:
FORMER OWNER INFORMATION
Owner Name: McNeill Family Partners,LP Owner Phone Number: 334 263 - 9070
Address: 3241 Money Road
City, State, Zip Code: Montgomery,AL 36108
1 certify under penalty of law that I am familiar with the above information,and 1 believe that this information is true,accurate and complete.
Signature of forme rowner Date: u' V 4
W OWNER INFORMATION
Owner (Compan Name PREM SYin Neil,LLC Contact Name:Kunal Kapadia
Owner Phone Number: 407 384 - 1168 Contact Phone Number: 407 384 - 1168
Address: 2018 S.Chickasaw rout Contact Email: kunal@sunstateoil.com
City, State, Zip Code: Orlando,FL 32825
Company Email:kumal tmalilteoil.core New Name of Facility: SAME
I certify under penalty ih 1 familiar wit meabovein rmabon,and l believe that mis information is/tr/ruue,accurate
aannd�complete.
Si nature of new owner. d Date: 0 �'d G-t/�
REQUIREMENTS
Any person who sells a un erground storage tank (UST) or an aboveground storage tank(AST)
system must:
• Notify the Department of transfer of ownership by fully completing this form and returning it to the Department within
30 days from the date of transfer,
• Provide proof of transfer of ownership of the system by signing this form,
Any person who receives ownership of an existing underground storage tank (UST) or an aboveground
storage tank (AST) system must:
Provide proof of transfer of ownership of the system by signing this form
Please return the completed form within 30 days of transferring ownership to the Department by
mail, email or fax.
Once the completed form is received by the Department,the new owner will receive a letter acknowledging their new ownership.
With the letter will be an ADEM"Notification for Underground Storage Tanks'form#279 and/or"Notification for Aboveground
Storage Tanks"form#283 that will be partially completed.The new owner should check for accuracy and complete the form,
SIGN AND DATE the form, and submit to the Department within 30 days of receipt. Once this process is complete,ADEM will
send the new owner a copy of the tank certificate to be displayed at the site.
Please Note: If the former owner does not sign this form, you must provide a warranty deed or other approved
legal documents for proof of ownership. In addition, if there are any unpaid UST regulatory fees due at the time of
this transfer of ownership,the new owner is responsible for submitting payment to the Department.
ADEM Form 469 2110 m2(revised 3/18)