HomeMy WebLinkAbout12725 015060 101 06-08-2021 CHIOWN LAH CHANGE IN OWNER 57620.06 PUEM
RECEIVED
CHIOWN 0 JUN 15 2021
2
ADEM G
UNDERGROUND AND ABOVEGROUND STORAGE TANK �aWATER
TRANSFER OF OWNERSHIP FORM
Alabama Dept. of Environmental Management Phone#(334) 270-5655
Groundwater Branch/Land Division Fax #(334)270.5631
P. O. Box 301463 E-mail: ustcompliance@adem.alabama.gov
Montgomery, AL 3 61 30-146 3 Web Site: adem.alabama.gov
FACILITY INFORMATION
Former Name of Facility: United Food&Fuel 410 1 ADEM Facility I.D. Number: 12899 - 101 - 15060
Location street or highway): 300 Coliseum Blvd No. of US included in transfer:2
City, County: Montgomery,Montgomery No. of ASTs Included in transfer: 0
Transfer of Ownership Date: / /
FORMER OWNER INFORMATION
Owner Name: MoNcilt 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 Famlllarwith the above Information,and I believe that this information Is tma,a/^ec�u(re�te aged complete.
Signature of fomao wk
ownet Date: O C'd 4-e�
OWNER INFORMATION
0 EM Su a I,LLC Contact Name: Kunal Kapadia
Owner Phone Number: 407 384 - 1168 1 Contact Phone Number: 407 384 - 1168
Address: 2018 S.Chickasaw Trail Contact Email: kunal@sunstaleoil.com
City,State, Zip Code: Orlando,FL 32825
Com an Ema' k ai@s stateoil.com A New Name of Facility:
I certiy under pena ty fla Mt am famlllarwilh the above rmatlon,andlbelievelhal mis information/i'sJtrue,accuQrate and complete.
Signature of new own v Dry /�2
Data
REQUIREMENTS
Any person who sell an nderground storage tank(US') 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 farm
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 ownerwlll 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 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 dead 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 V10 m2(revised 3/18)