HomeMy WebLinkAbout18156 UST230305 051 11-20-2024 INSP AEPACS SITE REGULATORY INSPECTION CIRCLE K #2709068 : S18770-51
UST Corrective Action Site Inspection Log
Site Inflirmatio
1. Incident Site Name CIRCLE K #2709068
2. Site Address 1167 HWY 14,
MILLBROOK, AL 36054
3. Facility Id Number 23413-051-018770
4. UST(or AST) Incident Number US71`23-03-05
5.ADEM File Code UST230305/INSP14141
Purpose of Site Inspection
Purpose Site Status/ Determine
Completion of Scope of
Work
00mmarvAf Findings
la. Date of Inspection 11/20/2024
It. Time of Arrival at Site 11:10 AM
lc. Time of Departure 11:20 AM
2. Residential Properly adjacent to release site? ❑Yes v❑No
3. Residential Property located within 300 feet of release site? ❑Yes ]No
4. Observations
Well abandonment inspection. All wells gone. Debris removed.
Si natures
Site Representative
la. Site Representative Name
lb. Site Representative Signature
lc. Site Representative Signature Date
ADEM Representative
2a.ADEM Representative Name James Robinson
2b. ADEM Representative Signature
7�K
2c. ADEM Representative Signature Date 11/20/2024
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CIRCLE K #2709068 : S18770-51
UST Corrective Action Site Inspection Log ADM
Si natu
ADEM Section Supervisor
3a.ADEM Section Supervisor Name John Dean
3b.CADEM Section Supervisor Signature
`1 r
3c. ADEM Section Supervisor Signature Date 11/20/2024
4. Supervisor Comments
Incident to be NFAd
2