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Home My WebLink About12880 ALR000042317 053 10-19-2020 CORR ALC 8700-12 Please Drint or Wasin the unshaded areas onlyADEM ram emo-tssroc Please refer to the ADEM (br ADEMUaOnly) Form Instmo Notification Notification of Regulated Flom ,nsfrec6ana baea ADEM Pled, Uia ram.. Waste Activity Information Ireqssue here is required by lew(§auto of the Remume Gonservafbn an0 Recovery Act). Alabama Department of Environmental Management I. Notification Class(Check appropriate box and enter ID number,if known.) Facility's EPA ID Number ALR000042319 ❑ Initial Notification ❑ Annual Notification II.Operating Name of Facility(Include company and specific site name) ESCAMBIA OPERATING COMPANY LLC FLOMATON TREATING FACILITY Operating Name of Facility Continue III.Change of Facility Name? El No ❑Yes(If Yes, enterprevious name ofFacilitybelow). IV.Location of Facility(Physical address no P.O.Box or Route Number) Street 4004 WOLF LOG ROAD City or Town State Zip Code FLOMATON AL 36441 V. Geographic Location (See Instructions) Methotl Latitude Longitude O 31.0354 -87.1410 County Name Escambia VI. Facility Contact(Person to be contacted regarding waste activities at site) Name First Last Ran Dum Job Title Phone Number Area Code and Number PLANT MANAGER 251-368-6732 Ext. Contact Email Address(Optional) Ldum@gri ndyemrgyllacom VII. Facility Mailing Address (See instructions) Street or P.O. Box PO DRAWER 1029 City or Town State Zip Code ATMORE AL 36504 Vill. Description of Facility Processes (See instructions for NAICS Code listings) A. Facility Process In the space provided below,describe each of the processes at your facility that produce Regulated Wastes. 1. 2. 3. 4. 5. B. NAICS Codes: Enter the six-digit North American Industry Classification System(NAICS)Code of the overall production,distribution, or service activity of your site.Also, provide any additional NAICS Codes that describe the specific industrial processes that are used. Primary 2 3 4 5 211I11 ADEM Form 8700-12(8104) Continued on Next Page Please orint or Wee in the unshaded areas only POEM Po,m MO-12(1NO3 IX. Ownership (see Instructions) A. Legal Name of Facility 17LOMATON TREATING FACILITY B. Name of Facility's Legal Owner 6ri221y Energy,LTC Street,P.O. Box or Route Number 5847 Ban Pelm, Bulte 300i) City or Town state Zip Code HOUSTON TX 77057 Phone Number(Area Code and Number) C.Land D.Owner E.Operator Change of Owner Date Changed Type Type Type Indicator 832-327-2255 Private Private Pdvak Yee❑ 0 No F. Name of Facility's On-Site Operator ESCAMBIA OPERATING COMPANY LLC Street,P.O. Box or Route Number PO DRAWER 1029 City or Town State Zip Code ATMORE AL 36504 Phone Number(Area Code and Number) 251-368-67M Ext. G. Name of Facility's Parent Company Gri221y Energy,LTC Street,P.O. Box or Route Number 5847 SAN FELIPE,STE.30M City or Town State Zip Code HOUSTON TX 77057 Phone Number(Area Code and Number) Change of Owner Data Changed Indicator 832-327-2255 Ext. 3814 Yes 0 [—]No 07/16/2019 H. Name of Facility's Property Owner Gd22ly Energy,LLC Street,P.O. Box or Route Number 5847 SAN FELIPE,STE.30M City or Town state Zip Code HOUSTON TX 77057 Phone Number(Area Code and Number) Change of Owner Date Changed Indicator 832-327-2255 Ext. 3814 Yes[7.] ❑ No 07/16/2019 Facility's EPA ID Number ADEM Form 8700-12(8104) ALRMUM2317 (Continued on Next Page) Page 2 Please print or type in the unshaded areas only X. Certification Status Note: Pursuant to Rules 335-1-6 of the ADEM Administrative Code,all Notification Forms submitted to the Department must Include the appropriate certification fee in order to be complete. Durina at least 2 month of the year,this facility will operate and/or maintain: (Check all that agp/v) A. Hazardous Waste Activities (Attach Schedule A) B. Used Oil Activities (Attach Schedule B) 1. ❑ Large Quantity Generator t—2,200 Ibs/month 1. ❑ Generator(t 25 gallons/month) (a 1,000 kg/month) 2. ❑ Transporter/Transfer Facility 2. Q Small Quantity Generator between 221 and 2,199 lbs/month 3. ❑ Processor/Re-refiner (between 101 and 999 kg/month) 3. ❑ Conditionally Exempt Generator<—220 Ibs/month 4. ❑ Fuel Marketer (s 100 kg/month) 5. ❑ Burner (Note:Household generation is exempt under335-14-2-01f4)(b)l.) 4. ❑Transporterfl-ransfer Facility C. Universal Waste Activities (Attach Schedule C) 5. ❑Treatment Facility—Combustion 1. ❑ Universal Waste Transporter 6. ❑ Treatment Facility—Other than Combustion 2. ❑ Large Quantity Handler t 11,020 Ibs 7. ❑ Storage Facility (a 5,000 kg) S. ❑ Disposal Facility 3. [f] Small Quantity Handler< 11,020 Ibs (< 5,000 kg) Any ADEM Form 8700-12 submitted without all appropriate wastes schedules and"Alreation fees will not be processed. XI. Certification I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel property gather and evaluate 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. Signature Name and Official Title(Type or PdnQ Data Signed Tammy Holland Envnomrent Amlyet 10/14/2020 XI. Comments omaon reamg pacluty is nowlus asimp ,Dowlerstation lorthes ms from well nemsm thearea toagaspan. Date Processed Iror 0m6.1 ua.ongl Mail completed form,a check or money order for all appropriate certification Alabama Department of Environmental Management fees, and all necessary schedules and attachments to: Permits 8 Services Division P.O.Box 301463 Montgomery,AL 36130-1463 ADEM Form 8700-12(8/04) Facility's EPA ID Number Page 3 A1R00oW117 Please prmt or type in the unshaded areas only XIII. Additional Information Sheet Facilit 's EPA ID Number ADEM Form 8700-12(8/04) AGt000042317 Page 4 Please Print or type In the unshaded areas only Please refer to the ADEM (for ADEM Use Only) Tom870U-12 Notification ' ADEM Form 8700-12 co Instructions before Schedule A completing leting this form. Information requested here Is required bylaw(§3010 of Certification of Hazardous the Resource Conservation and Recovery Act). - Waste Management I.Type of Hazardous Waste Activity (Mark X in the appropriate boxes,See Ins n ctlons) Q A. Hazardous Waste Generator ❑ C.Treatment,Storage, Disposal Facility(at Facility)tt ❑ 1. 2,2001be (1,000 kg)per month or more(LQG) ❑ 1. Facilities subject to Permit Q 2. 221 to 2,1991bs(101-999 kg)per month (BOG) ❑ a. Operating Units ❑ c. Post closure Care ❑ 3. 220 Ibs(100 kg) per month or less(CESQG) ❑ b. SWMU CA ❑d. Other(Specify) ❑4. United States Importer of Hazardous Waste ❑ 2. Permit Exempt Treatment(subject to ADEM verification) ❑ B. Hazardous Waste Transporter/Transfer Facility tt ❑ a. W WTU/ENU ❑ J. Generator Evaporation ❑ 1. Commercial Transporter(received wastes from others) ❑ b. Recycling Unit❑ e. Generator Physical Processing ❑a.Air ❑d.Water ❑ c.TETF❑ f. Other(Specify) ❑ b. Rail ❑e. Other(Specify) ❑ D. Hazardous Waste Fuel Activity tt ❑c. Highway ❑ 1. Blender Marketing to Burner ❑ 2. Self Transporter(Own Waste Only) ❑ 2. Other Marketers ❑ Transfer Facility ❑ 3. Boiler and/or Industrial Furnace ❑ a. Loaded trucks ❑ a. Smelter Deferral ❑ b. Small Quantity Exemption ❑ b. Off-loaded containers ❑ E. Recycling Activities (Specify) ❑ c. Bulk Transfer between vehicles tt Note:A permit may be required for this activity, Contact 334 271-7730 for more information. II. Hazardous Waste Generation A Waste Description In Me hx-r itle4 at Our type..olreBubfae.1.fnhcsw,nu later.Ey ywr..c,Adi eraionel.4reeN es nsooi, Types of Waste Generated Estimated Yearly Generation in the. 1 OIL @WAST-$PENT SOLVENTS,WAST PAINTS, 900 2 VACUUM TRUCK RINSATES 12500 3 TANK BOTTOMS TO WASTE RECLAINIERS AND 2100 4 DRUMS OF INSULATION AND REFRACTORY 500 B. Characteristics of Nonlisted Hazardous Wastes.(Markx'mthe boxes chmesponding to the chamclensres othomistednamroous wasters pur Facii handles;See 335-14-2-01—f5).Adddbnel spaces are available on the Supplemental page If you head M list mom hazardous waste numbers) ❑ 1. Ignitable(DO01) Q 2.Corosive(D002) ❑ 3. Reactive(D003) iJ 4.Toxicity Characteristic (List specific EPA hazardous waste numbers)for the Toxicity characteristic contaminants)) C. Listed Hazardous Wastes See 335-14-2-.04 2 -(4));Attach the Supplemental page if you need to list more hazardous waste numbers ADEM Form 8700-12 A(8I04) Facility's EPA ID Number Page 1 7 5 000042317 It. Hazardous Waste Generation (continued) III. Hazardous Waste Transporterrrransfer Facility During a typical year,this facility transportsitransfers of Hazardous Waste. (quantity in pounds) IV.Treatment, Storage, Disposal Facility (at Facility) During a typical year,this facility treats of Hazardous Waste. (quantity in pounds) During a typical year,this facility stores of Hazardous Waste. (quantity in pounds) During a typical year,this facility disposes of Hazardous Waste. (quantity in pounds) V. Hazardous Waste Fuel Activity During a typical year,this facility markets of Hazardous Waste. (quantity in pounds) During a typical year,this facility combusts of Hazardous Waste. (quantity in pounds) VI. Recycling Activity During a typical year,this facility recycles of Hazardous Waste. (quantity in pounds) Note: In order for this schedule to be accepted by ADEM, it must be attached to a completed Notification of Regulated Waste Activity,ADEM Form 8700-12, and must include the appropriate certification fees,as required by 335-1-6. Comments: Facility's EPA ID Number ADEM Form 8700-12 A(8I04) ACR000042317 Page 2 II. Hazardous Waste Generator(Supplemental) D. Listed and NOnlisted Hazardous Waste Codes.(See 335-14-2-.04(2)—(4)and 33514-2-.03(1)—(5))If you need to list more hazardous waste numbers,attach copies of this page as necessary ADEM Form 8700-12 A(8104) Facility's EPA ID Number Page AL800004"17 II. Hazardous Waste Generator(Supplemental) D. Listed and NOnlisted Hazardous Waste Codes.(See 335-14-2-.04(2)—(4)and 33514-2-.03(1)—(5))If you need to list more hazardous waste numbers,attach copies of this page as necessary ADEM Form 8700-12 A(8104) Facility's EPA ID Number Page 11,1111,17 Please Drint or nice In the unshadetl areas only Please refer to Me ADEM (for ADEM Use Only) Fore 8700-12 Notification ADEM Form 8700-12 Form Instructions before Schedule B completing this form. Information requested Resource here is required by law(§ Certification of Used Oil Ccna of the Resource Recovery Act).ervation and Management I.Type of Used Oil Management Activity(See Instructions) ❑A. Used Oil GeneralorlCollector ❑ C. Off-Specification used Oil Burner ❑ 1. On-site Generation Only ❑ 1. Burns Only Off-Specification Used Oil Generated On-Site ❑ 2. Do-it-yourself Collection Center(i.e., from off-site source) ❑ 2. Indicate Types)of Devices ❑ 3. Collection Center(i.e.,from off-site source) ❑ a. Utility Boiler ❑ c. Industrial Furnace ❑ 4. Aggregation Point(i.e.,from off-site source) ❑ b. Industrial Boiler ❑ B. Used Oil Fuel Marketer ❑ D. Used Oil Transporter tt ❑ 1. Directs Shipment of Used Oil to Off-Specification Burner ❑ 1. Only For Used Oil Generated On-site ❑ 2. First Claims Used Oil Meets Specification Fuel E]2. Operates a Transfer Facility ❑ 3. burns Only Used Oil Generated On-site as ❑ E. Used Oil ProcessoriRe-refiner On-Specification Fuel ft NOTE:A permit is required for this activity,Contact 334 271-7758 for more information It. Used Oil Generation During a typical year,this facility collects/generates of Used Oil. (quantity inpounds) III. Used Oil Fuel Marketer During a typical year,this facility markets of Used Oil. (quantity inpounds) IV. Used Oil Burner During a typical year,this facility burns of Used Oil. (quantity inpounds) V. Used Oil Transporter During a typical year,this facility transports of Used oil. (quantity inpounds) VI. Used Oil ProcessorlRer-refiner During a typical year,this facility processeslre-refines of Used Oil. (quantity inpounds) Note: In order for this schedule to be accepted by ADEM, it must be attached to a completed Notification of Regulated Waste Activity,ADEM Form 8700-12, and must include the appropriate certification fees,as required by 335-1-6. Comments: ADEM Form 8700-12 B (8104) Facility's EPA ID Number Page 1 . 0000"17 Please Drint or nice In the unshaded areas only Please refer to Me ADEM (for ADEM Use Only) Forth 8700-12 Notification ADEM Form 8700-12 Form tang Instructions before Schedule C completing this form. Schedule here Inform requested here isf the bylaw(e Certification of Universal Cc nuerwdlon of the Resource Recovery Act). and Waste Management I.Type of Used Universal Waste Activity(See Instructions) ❑ A. Universal Waste Transporter ❑ B. Large Quantity Handler Estimated Yearly Amount(in Ibs) Accumulated Generated 1. Battery(ies) 2. Pesticide(s) 3. Thermostat(s) 4. Lamps 5. Other(specify) Q C.Small Quantity Handler Estimated Yearly Amount(in Has) Accumulated Generated 1. Battery(ies) 100 100 2. Pesticide(s) 3. Thermostat(s) 4. Lamps Iv In 5. Other(specify) It. Universal Waste Transporter During a typical year,this facility transports of Universal Waste. (quantity in pounds) III. Universal Waste Handler 150 During a typical year,this facility handles of Universal Waste. (quantity in pounds) Note: In order for this schedule to be accepted by ADEM, it must be attached to a completed Notification of Regulated Waste Activity, ADEM Form 8700-12, and must include the appropriate certification fees, as required by 335-1-6. Comments: ADEM Form 8700-12 C(8I04) Facility's EPA ID Number Page ALR0001,317