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Home My WebLink About12748 XXX 125 06-15-2021 ORIG CJO 164812 SOLID WASTE DISPOSAL CERTIFICATION REVIEW FORM CERTIFICATION NUMBER: SW-063023-0047 WASTE PROFILE NUMBER: 164812 2021 ADEM STATUS DATE: 06/16/2021 GENERATOR NAME: THE UNIVERSITY OF ALABAMA EPAID: THE UNIVERSITY OF ALABAMA PHONE: (205)348-4809 120514TH STREET TUSCALOOSA,AL 35487 CONTACT: MR DAN SANBURN DATE RECEIVED: 06/15/2021 DATE REVIEWED: 06/16/2021 LANDFILL NAME: Black Warnor Solid Waste Facility PERMIT NUMBER: 63-01 ASSIGNED PERSON: cjo Ms.Cale Obenauf WASTE NAME: FRIABLE ASBESTOS COUNTY: TUSCALOOSA STATE: AL QUANTITY: 0.00 PER- FORM TYPE: O O= ORIGINAL R=RENEWAL FOUNDRY SAND: N STATUS CODE: (A) COMMENT: TUSCALOOSA CO IS WITHIN THE SERVICE AREA OF BLACK WARRIOR EMAIL PORTER MCCOLLISTER Non-contaminated(below lim) _Petro<or=100 ppm _Petro> 100 ppm_Non-haz<50%TCLP_Non-haz>or=50q TCLP Date: Reviewed by: RESERVED ! COBENAUF O6/16/2021 10:13 am ! 1 From: Porter mccollister TO: land Waste Anomval Aooliotions Subject Request for Solid Waste Frolic Date: Tuesday,June 15,20212:57:09 PIA Attachments: Form 300,ixf Please find attached our form 300 plus proof of fee payment. Thanks, Porter McCollister Montgomery Environmental 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: University of Alabama Generator Physical Address: Osband Hall, 814 6th.Ave., Tuscaloosa,AL Generator County: Tuscaloosa EPA ID: Generator Mailing Address: 413 Cahaba Circle,Tuscaloosa,AL 35404 Generator contact: Suzanne Webster role: Project Manager Phone: 205-348-6907 Email: scirbywebster@ua.edu Submitted by(if different from above): Company Name: Montgomery Environmental, Inc Contact: Porter McCollister, Pres Mailing Address: PO Box 531188, Birmingham,AL 36253 Phone: 205-790-4774 c Email: portermccollister@gmail.com Waste Information Process Generating Asbestos Abatement of Osband Hall Waste: Friable&Non-friable asbestos including Vf flooring&mastic,Pipe insulation and asbestos plaster ceiling skim coat. Waste Name: Friable Asbestos If this waste is subject to Corrective Action regulations 40 CFR Part 280(UST)provide the following Information: UST Facility ID# UST Incident# Source of Petroleum Contamination(Gas, Diesel, Used Oil,Hydraulic Oil,etc.): Does the waste contain any of the following: ❑PCBs ❑Cyanides ❑Sulfides ®Asbestos Concentration: Units: ❑mg/L ❑mg/Kg ❑PPM ❑PPB Waste Type: ®Remediation ❑Process ❑CERCLA Cleanup []Other Waste Volume: 150 Units: CY Frequency: ®Annual ❑Ouartedy []Monthly Waste Prooerdes 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 335-13-4-.26(3)? DYES ENO Is this Wood Ash handled in accordance to ADEM Code 335-13-4-.26(6)? DYES ENO Landfill Name#1: Black Warrior Solid Waste Landfill Perron#: 63-01 R Landfill Name#2: Permit#: Landfill Name#3 Permit#: Landfill Name#4: Permit It Current Profile No.(d applicable) ADEM Form 300 XX/18 mods Page 1 of 2 Alabama Department of Environmental Management Solid Waste Profile Sheet Form 300 Continuation Form Process Generating Waste continued: u+Vaaary✓u wNnNoT moc qPo mapee«wnBeummn 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. Porter M P,ollis r Pres.,Montgomery Environmental Name a rint) Title 8/152021 Signature Date ADEM Form 300 XX/18 m3 Page 2 of 2 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 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 Summary Payment earn Fee Cnline Payment-06116/202114:5217 521600 Total Fee through Alabama.gov fceare inho $221.45 Receipt Confirmation Number: 20210615000026806 General Invoice Information Choose the type of payment you are making:5359-LAND-SOLID WASTE LANDFILL PERMIT Description of Other Fees: Additional Information/Fee Description:Solid Waste Profile Fee Number on your ADEM invoice: Date on your ADEM invoice: Contact Information Company/Facility or Individual Name: Montgomery Environmental Facility Permit Number(e applicable): Company or Facility Phone: Conrad Pelson: Porter McCollister Contact Phone:205-7904774 Contact email address: pormnnocollister@gmail ours Name of an ADEM Program Staff Member(if knowm):Cale Obenauf Policy Related Queatians:334-271-7700 Application Support:866-353-3468 or 5uir own@alabema nte2ct ve Version 2.0.0