RESOLUTION NO. NOW, THEREFORE BE IT RESOLVED by the Board of Commissioners of the City of Dothan, Alabama, as follows:

Transcription

1 RESOLUTION NO. WHEREAS, the City of Dothn owns nd opertes boveground petroleum storge tnks s prt of the Dothn Utilities wstewter tretment nd wter production opertions, nd WHEREAS, the Albm Deprtment of Environmentl Mngement (ADEM) provided notifiction to the City tht registrtion of ll boveground storge tnks covered by the Spill Prevention, Control, nd Countermesure (SPCC) rule hving n boveground oil storge cpcity greter thn 1,320 gllons is required, nd WHEREAS, the City desires to provide registrtion notifiction to ADEM for the following boveground petroleum storge tnk loctions in ccordnce with the SPCC rule: Little Choctwhtchee Wstewter Tretment Plnt (WWTP), Omussee Creek WWTP, New Cypress Creek WWTP, Wter Production Well #31, nd Wter Production Well #33. NOW, THEREFORE BE IT RESOLVED by the Bord of Commissioners of the City of Dothn, Albm, s follows: Section 1. Tht bsed upon the recommendtion of the Dothn Utilities Director, the City of Doth~n execute the ADEM Notifiction for Aboveground Storge Tnks documents for the following Dothn Utilities operting loctions: Little Choctwhtchee Wstewter Tretment Plnt (WWTP), Omussee Creek WWTP, New Cypress Creek WWTP, Wter Production Well #31, nd Wter Production Well #33, which sid documents follow:

2 Notifiction for Aboveground Storge Tnks FOR Return Albm Dept. of Environmentl Mngement STATE USE ONLY TANKS Completed Groundwter Brnch IN Form P. O. Box AL To Montgomery, AL I. D. Number NOTIFI INSTRUCTIONS Plese type or print ll items except 'signture" in Section XII. This form must be completed for ech loction contining boveground Indicte number of continution sheets storge tnks. If more thn 5tnks re owned t this loction, photocopy, nd stple continution sheets to this fonn. ttched I. OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) Fcility I. D. # _ - - Fcility Nme Little Choctwhtchee Wstewter Tretment Plnt - -- or Compny Site Identifier, s pplicble (Unless New Loction) Owner City of Dothn (Corportion, Individul, Public Agency, or Other Entity) Miling 126 N. Sint A,Street City Dothn Stte AL Zip Contct Mike Schmitz, Myor Phone# {334} Fx# {334} E-mil ddriskell@dothn.org Type of Owner DStte Gov'! DPnvte ofederl Gov't (ZI Locl Gov't (GSA Fcility I.D. \ III. OPERATOR OF TANKS Nme(lf sme s section I, mrk box here OJ Street 412 Clerwter Drive County Rod, Highwy, or Stte Rod, s pplicble Houston City Dothn StteAL Zip (Nerest) Contct Chris Dvis..._ Phone # (334} Indicte number of boveground Mrk box here iftnk(s) D storge tnks t this loction re locted on lnd within n Indin reservtion or Indicte number of underground on other Indin trust lnds storge tnks t this loction IV. CONTACT PERSON AT TANK LOCATION Nme (If sme s section III, mrk box here [lh LDon Driskell Opertor Nme(Corportion, Individul, Public Agency, or Other Entity) Miting Address 412 Clerwter Drive City Dothn StteAL Zip LDon Driskell Nme of Individul Job Title Phone Numberj l Phone Number r V. TYPE OF NOTIFICATION If this is new notifiction for this loction mrk box here ~ If this is n mended or subsequent notifiction for this loction, mrk box here [J VI. TRUST FUND ELIGIBILITY INFORMATION THE FOLLOWING IS REQUIRED TO BE ELIGIBLE FOR THE ALABAMA ABOVEGROUND STORAGE TANK TRUST FUND The tnk must be registered with the underground storge tnk section of ADEM. A copy of registrtion certificte is proof of registrtion. The tnk must contin motor fuel, nd not be excluded by the trust fund regultions. The tnk must be in SUbstntil complince with the pplicble requirements below t the time of the discovery of the relese with the following (For informtion cll ADEM t (3M) ). Spill Prevention Control & Countermesure (SPCC) pln prepred by registered professionl engineer. NPDES or SID stormwter permit. The relese must hve occurred fter August 1, The tnk cnnot be owned by the stte or federl government. ADEM Form # 283 1/2010 Issue Dte: 1996 CONTINUE ON NEXT PAGE

3 Owner Nme City of Dothn loction 412 Clerwter Drive, Dothn AL Pge No.2 (from Section I) (from Section II) VII. DESCRIPTION OF ABOVEGROUND STORAGE TANKS (Com~ lete for ech tnk t this loction) Tnk Identifiction No. Tnk No. Tnk No. Tnk No. Tnk No. Tnk No. Arbitrrily Assigned Sequentil Number (e.g. l, 2, 3) 1 A. Tnk Sttus (Mrk ll tht pply) 1. Currently in use x 2. Temporrily closed. Estimted dte lst used (month/yer) / / / / / b. Estimted quntity of substnce remining (gllons) gl. gl. gl. gl. gl. 3. Permnently closed B. Tnk Loction (Mrk ll tht pply) 1. Locted bove ground x. Within 300 feet of privte well b. Within 1000 feet of public wter supply well c. Within well hed protection re 2. Locted in n underground re such s bsement, cellr, mineworking, drift, shft, or tunnel, nd is situted upon or bove the floor surfce. (NOTIFICATION NOT REQUIRED) C. Tnk History 1. Dte instlled (month/dy/yer) 01 /01 /11 / / / f / / / / 2. Dte sold by this owner (month/dy/yer) / / / / / f / / / / 3. Dte bou!!ht by this owner (month/dylver) / / / / / f / / / / D. Tnk Estimted Totl Cpcity (gllons) 10,000 gl. gl. gl. gl. gl. E. Substnce Currently Stored (Mrk ll tht pply) 1. Petroleum. Unleded!!soline b. Midi! rde gsoline c. Premium!!soline d. Diesel x e. Kerosene f. Avition fuel (JP4, etc.) g. Used oil h. Vir!!in oil i. E-85 i. B-20 Biodiesel k. Other, plese specify F. Tnk Use (Mrk ll tht pply) 1. Ememency power!!enertor x 2. Retil 3. Bulk fcility x 4. Industril 5. Locl!!ovemment x 6. Stte/Federl government 7. Frm/residentil 8. Pipeline terminl tnk, refinery terminl tnk, ril nd brge terminl tnk, hetin!! oil (NOTIFICATION NOT REQUIRED) VIII. CERTIFICATION (Red nd sign fter completing Sections I. ThrouQh VII. I certify under penlty of lw tht I hve personlly exmined nd m fmilir with the informtion submitted in this nd ll ttched documents, nd tht bsed on my inquiry of those individuls responsible for obtining the informtion, I believe tht the submitted informtion is true, ccurte, nd complete. Nme &officil title of tnk opertor or uthorized representtive Dte Signed Ldon Driskell, Wstewter Tretment Supervisor SiQnture~,-. ). hl '.l~/ 3/J/ /dojs- Nme &officil title of tnk!1!'!!1!ll: or uthorized representtive Mike Schmitz, Myor Dte Signed Signture ADEM Form # 283 1/2010

4 . Notifiction for Aboveground Storge Tnks FOR Return Albm Dept. of Environmentl Mngement STATE USE ONLY TANKS Completed Groundwter Brnch IN Form P. O. Box Al To Montgomery, AL I. D. Number NOTIFI INSTRUCTIONS Plese type or print ll items except 'signture" in Section XII. This form must be completed for ech loction contining boveground Indicte number of continution sheets storge tnks. If more thn 5tnks re owned t this loction, photocopy, nd stple continution sheets to this form. ttched 1 0 I I. OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) FcilityI.D.# - - (Unless New Loction) Owner Nme Ci!y of Dothn (Corportion, Individul, Public Agency, or Other Entity) Miling Address 126 N. Sint Andrews Street City Dothn Stte AL Zip Contct Mike Schmitz, Myor Phone # (334) Fx# (334) E-mil myor@dothn.org Type of Owner DStte Gov't DPrivte DFederl Gov't ILlLocl Gov't (GSA Fcility 1.0. No. ) III. OPERATOR OF TANKS Nme(lf sme s section I, mrk box here 0) Fcility Nme Omussee Creek Wste Wter Tretment Plnt or Compny Site Identifier, s pplicble Street 457 Jerry Drive County Rod. Highwy. or Stte Rod. s pplicble County Houston City Dothn StteAL Zip (Nerest) Contct Jeffrey Dykes Phone # (334} Indicte number of boveground D Mrk box here if tnk(s) D storge tnks t this loction Indicte number of underground D storge tnks t this loction re locted on lnd within n Indin reservtion or on other Indin trust lnds IV. CONTACT PERSON AT TANK LOCATION Nme (If sme s section III, mrk box here ill> LDon Driskell Opertor Nme(Corportion, Individul, Public Agency, or Other Entity) Miling Address 412 Clerwter Drive City Dothn StteAL Zip Contct LDon Driskell Nme of Individul Job Title Phone NumbeU ) Phone Number J) V. TYPE OF NOTIFICATION If this is new notifiction for this loction, mrk box here ~ If this is n mended or subsequent notifiction for this loction, mrk box here D VI. TRUST FUND ELIGIBILITY INFORMATION THE FOLLOWING IS REQUIRED TO BE ELIGIBLE FOR THE ALABAMA ABOVEGROUND STORAGE TANK TRUST FUIIJD The tnk must be registered with the underground storge tnk section of ADEM. A copy of registrtion certificte is proof of registrtion. The tnk must contin motor fuel, nd not be excluded by the trust fund regultions. The tnk must be in substntil complince with the pplicble requirements below t the time of the discovery of the relese with the following (For informtion cn ADEM t (334) ). Spill Prevention Control & Countermesure (SPCC) pln prepred by registered professionl engineer. NPDES or SID stormwter permit. The relese must hve occurred fter August 1,1993. The tnk cnnot be owned by the stte or federl government. ADEM Form # 283 1/2010 Issue Dte: 1996 CONTINUE ON NEXT PAGE

5 Owner Nme City of Dothn Loction 457 Jerry Drive, Dothn, AL Pge No.2 (from Section I) (from Section II) VII. DESCRIPTION OF ABOVEGROUND STORAGE TANKS (Complete for ech tnk t this loction) Tnk Identifiction No. Tnk No. Tnk No. Tnk No. Tnk No. Tnk No. Arbitrrily Assi!lned Sequentil Number (e.!l. l, 2, 3) 1 A. Tnk Sttus (Mrk ll tht pply) 1. Currently in use x 2. Temporrily closed. Estimted dte lst used (month/ver) / / / / / b. Estimted quntity of substnce remining (gllons) gl. gl. gl. gl. gl. 3. Permnentlv closed B. Tnk loction (Mrk ll tht pply) 1. Locted bove Qround x. Within 300 feet of privte well b. Within 1000 feet of public wter supply well c. Within well hed protection re 2. Locted in n underground re such s bsement, cellr, mineworking, drift, shft, or tunnel, nd is situted upon or bove the floor surfce. (NOTIFICATION NOT REQUIRED) C. Tnk History 1. Dte instlled (month/dy/yer) 06 /01 /90 / / / / / / / / 2. Dte sold by this owner (month/dy/yer) / / / / / / / / / / 3. Dte bouq ht bv this owner (month/dv!ver) / / / / / / / / / / D. Tnk Estimted Totl Cpcity lqllons) gl. gl. gl. gl. gl. E. Substnce Currently Stored (Mrk ll tht pply) 1. Petroleum. Unleded Qsoline b. Midilrde gsoline c. Premium gsoline d. Diesel x e. Kerosene f. Avition fuel (JP-4, etc.) g. Used oil h. VirQin oil i. E-85 j. B-20 Biodiesel k. Other, plese specify F. Tnk UsQe (Mrk ll tht pply) 1. Ememency power Qenertor x 2. Retil 3. Bulk fcilitv 4. Industril 5. Locl government x 6. Stte/Federl Qovemment 7. Frm/residentil 8. Pipeline terminl tnk, refinery terminl tnk, ril nd brge terminl tnk, hetinq oil (NOTIFICATION NOT REQUIRED) VIII. CERTIFICATION (Red nd sign fter completin Sections I. ThrouQh VII. I certify under penlty of lw tht I hve personlly exmined nd m fmilir with the informtion submitted in this nd ll ttched documents, nd tht bsed on my inquiry of those individuls responsible for obtining the informtion, I believe tht the submitted informtion is true, ccurte, nd complete. Nme &officil title of tnk opertor or uthorized representtive Dte Signed Ldon Driskell, Wstewter Tretment Supervisor Signture ~ L'h... ~'L. Lj'~ 3/!'~rJJS- Nme &o'fficil title of tnk Qlil1Jl! or uthorized representtive Mike Schmitz, Myor Dte Signed Signture ADEM Form # 283 1/2010

6 ~ Notifiction for Above~round Stor~e Tnks FOR Return Albm Dept. of Environmentl Mngement STATE USE ONLY TANKS Completed Groundwter Brnch IN Form P. O. Box I. D. Number To Montgomery, AL Al NOTIFI INSTRUCTIONS Plese type or print ll items except 'signture' in Section XII. This form must be completed for ech loction contining boveground Indicte number of continution sheets storge tnks. If more thn 5 tnks re owned t this loction, photocopy, nd stple continution sheets to this form. ttched 0 1 I I. OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) FcilityI.D.# - (Unless New Loction) Owner Nme Ci~ of Dothn (Corportion, Individul, Public Agency, or Other Entity) Miling Address 126 N. Sint Andrews Street City Dothn Stte AL Zip Contct Mike Schmitz, M~or Phone # (334) Fx# (334) E-mil myor@dothn.org Type of Owner DStte Gov't DPrivte DFederl Gov't (ZI Locl Gov't (GSA Fcility I.D. No. ) III. OPERATOR OF TANKS Nme(lf sme s section I, mrk box here 0) Fcility Nme New C~~ress Creek Wste Wter Tretment Plnt or Compny Site Identifier, s pplicble Street 2431 Helms Rod County Rod, Highwy, or Stte Rod, s pplicble County Houston City Dothn StteAL Zip (Nerest) Contct Kevin Snell Phone # (334) Indicte number of boveground D Mrk box here iftnk(s) D storge tnks t this loction Indicte number of underground D storge tnks t this loction re locted on lnd within n Indin reservtion or on other Indin trust lnds IV. CONTACT PERSON AT TANK LOCATION Nme (If sme s section III, mrk box here Ill> LDon Driskell Opertor Nme(Corportion, Individul, Public Agency, or Other Entity) Miling Address 412 Clerwter Drive City Dothn Stte AL Zip Contct LDon Driskell Nme of Individul Job Title Phone Numberj l Phone Number _L V. TYPE OF NOTIFICATION If this is new notifiction for this loction, mrk box here ~ If this is n mended or subsequent notifiction for this loction, mrk box here 0 VI. TRUST FUND ELIGIBILITY INFORMATION THE FOLLOWING IS REQUIRED TO BE ELIGIBLE FOR THE ALABAMA ABOVEGROUND STORAGE TANK TRUST FUND The tnk must be registered with the underground storge tnk section of ADEM. A copy of registrtion certificte is proof of registrtion. The tnk must contin motor fuel, nd not be excluded by the trust fund regultions. The tnk must be in substntil complince with the pplicble requirements below t the time of the discovery of the relese with the following (For informtion cll ADEM t (334) ). Spill Prevention Control & Countermesure (SPCC) pln prepred by registered professionl engineer. NPDES or SID stormwter permit. The relese must hve occurred fter August 1, The tnk cnnot be owned by the stte or federl government. ADEM Form # 283 1/2010 Issue Dte: 1996 CONTINUE ON NEXT PAGE

7 Owner Nme City of Dothn Loction 2431 Helms Rod, Dothn, AL Pge No.2 (from Section I) (from Section II) VII. DESCRIPTION OF ABOVEGROUND STORAGE TANKS (Complete for ech tnk t this loction) Tnk Identifiction No. Tnk No. Tnk No. Tnk No. Tnk No. Tnk No. Arbitrrily AssiQned Sequentil Number (e.!:!. l, 2, 3) 1 A. Tnk Sttus (Mrk ll tht pply) 1. Currently in use x 2. Temporrily closed. Estimted dte lst used (month!yer) / / / / / b. Estimted quntity of substnce remining (gllons) gl. gl. gl. gl. gl. 3. Permnently closed B. Tnk loction (Mrk ll tht pply) 1. locted bove ground x. Within 300 feet of privte well b. Within 1000 feet of public wter supply well c. Within well hed protection re 2. locted in n underground re such s bsement, cellr, mineworking, drift, shft, or tunnel, nd is situted upon or bove the floor surfce. (NOTIFICATION NOT REQUIRED) C. Tnk History 1. Dte instlled (month/dy!yer) 2 /01 /02 / / / / / / / / 2. Dte sold by this owner (month/dy!yer) / / / / / / / / / / 3. Dte bou~ ht by this owner (month/dy/yer) / / / / / / / / / / D. Tnk Estimted Totl Cpcity (gllons) gl. gl. gl. gl. gl. E. Substnce Currently Stored (Mrk ll tht pply) 1. Petroleum. Unleded ~ soline b. Mid.grde gsoline c. Premium gsoline d. Diesel x e. Kerosene f. Avition fuel (JP-4, etc.) g. Used oil h. Virgin oil i. E-85 j iodiesel k. Other, plese specify F. Tnk Usge (Mrk ll tht pply) 1. Emergency power ~ enertor x 2. Retil 3. Bulk fcility 4. Industril 5. locl government x 6. Stte/Federl ~ovemment 7. Frm/residentil 8. Pipeline terminl tnk, refinery terminl tnk, ril nd brge terminl tnk, heting oil (NOTIFICATION NOT REQUIRED) VIII. CERTIFICATION (Red nd sign fter completino Sections I. Throuoh VII. I certify under penlty of lw tht I hve personlly exmined nd m fmilir with the informtion submitted in this nd ll ttched documents, nd tht bsed on my inquiry of those individuls responsible for obtining the informtion, I believe tht the submitted informtion is true, ccurte, nd complete. Nme &officil title of tnk opertor or uthorized representtive Dte Signed Ldon Driskell, Wstewter Tretment Supervisor Signture c>2"cf)2f'~ ~"A I J} jj/j 3/1 l/;2(] 1. \ Nme &officil title of tnk ~ or uthorized representtive Mike Schmitz, Myor Dte Signed Signture ADEM Form # 283 1/2010

8 J _ t Notifiction for Above~round StorQe Tnks FOR Return Albm Dept. of Environmentl Mngement STATE USE ONLY TANKS Completed Groundwter Brnch IN Form P. O. Box Al To Montgomery, AL I. D. Number NOTIFI INSTRUCTIONS Plese type or print ll items except 'signture' in Section XII. This form must be completed for ech loction contining boveground Indicte number 01 continution sheets storge tnks. If more thn 5 tnks re owned t this loction, photocopy, nd stple continution sheets to this lonn. ttched 1 0 I I. OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) Fcility I. D. # - - Fcility Wter Production Well # or Compny Site Identifier, s ppljcble (Unless New Loction) Owner Nme Ci!A' of Dothn (Corportion, Individul, Public Agency, or Other Entity) Miling Address 126 N. Sint Andrews Street CitvDothn Stte AL Zio36303 Contct Mike Schmitz, Myor Phone # (334) Fx# (334) "",n.org Type 01 Owner OStte Gov't oprivte OFederl Gov't tzilocl Goy't (GSA Fcility 1.0. ) III. OPERATOR OF TANKS Nme(ll sme s section I, mrk box here 0) Street 255 Hicks Rod County Rod, Highwy, or Stte Rod, s pplicble Houston Citv Dothn StteAL Zio36345 (Nerest) Contct Donnie Bedsole Phone # (334} Indicte number 01 boveground 1 storge tnks t this loction Indicte number 01 underground D storge tnks t this loction Mrk box here il tnk(s) re locted on lnd within n Indin reservtion or on other Indin trust lnds IV. CONTACT PERSON AT TANK LOCATION Nme (If sme s section III, mrk box here Ilh Pt Leonrd Opertor Nme(Corportion. Individul. Public Agency. or Other Entity) Miling i 200 KiIQore Drive City Dothn StteAL Zip Nme of Individul Job Title Contct Pt Leonrd Phone Number ( \ Phone Number 334 i V. TYPE OF NOTIFICATION If this is new notifiction for this loction mrk box here rzi If this is n mended or subsequent notifiction for this loction, mrk box here [] VI. TRUST FUND ELIGIBILITY INFORMATION THE FOLLOWING IS REQUIRED TO BE ELIGIBLE FOR THE ALABAMA ABOVEGROUND STORAGE TANK TRUST FUND The tnk must be registered with the underground storge tnk section of ADEM. A copy of registrtion certificte is proof of registrtion. The tnk must contin motor fuel, nd not be excluded by the trust fund regultions. The tnk must be in substntil complince with the pplicble requirements below t the time of the discovery of the relese with the following (For Informtion cll ADEM t (334) ). Spill Prevention Control & Countermesure (SPCC) pln prepred by registered professionl engineer. NPDES or SID stormwter permit. The relese must hve occurred fter August 1, The tnk cnnot be owned by the stte or federl government. ADEM Form # 283 1/2010 Issue Dte: 1996 CONTINUE ON NEXT PAGE

9 Owner Nme City of Dothn Loction 255 Hicks Rod, Dothn, AL Pge No.2 (from Section I) (from Section II) VII. DESCRIPTION OF ABOVEGROUND STORAGE TANKS (Complete for ech tnk t this loction) Tnk Identifiction No. Tnk No. Tnk No. Tnk No. Tnk No. Tnk No. Arbitrrily Assicmed Sequentil Number (e.. l, 2, 3) 1 A. Tnk Sttus (Mrk ll tht pply) 1. Currently in use x 2. Temporrily closed. Estimted dte lst used (month/yer) b. Estimted quntity of substnce remininq (Qllons) gl. gl. gl. gl. gl. 3. Permnently closed B. Tnk Loction (Mrk ll tht pply) 1. Locted bove ground x. Within 300 feet of privte well b. Within 1000 feet of public wter supply well x c. Within well hed protection re x 2. Locted in n underground re such s bsement, cellr, mineworking, drift, shft, or tunnel, nd is situted upon or bove the floor surfce. (NOTIFICATION NOT REQUIRED) C. Tnk History 1. Dte instlled (month/dy/yer) / Dte sold by this owner (month/dy/yer) Dte bought by this owner (month/dy/yer) D. Tnk Estimted Totl Cpcity (qllons) 2305 gl. gl. gl. gl. gl. E. Substnce Currently Stored (Mrk ll tht pply) 1. Petroleum. Unleded gsoline b. Mid~rde Qsoline c. Premium gsoline d. Diesel x e. Kerosene f. Avition fuel (JP-4, etc.) Q. Used oil h. Virgin oil i. E-85 i. B-20 Biodiesel k. Other, plese specify F. Tnk Usge {Mrk ll tht pply) 1. Emergency power genertor x 2. Retil 3. Bulk fcility 4. Industril 5. Locl government 6. Stte/Federl government 7. Frmlresidentil 8. Pipeline terminl tnk, refinery terminl tnk, ril nd brge terminl tnk, heting oil (NOTIFICATION NOT REQUIRED) VIII. CERTIFICATION (Red nd si~1" fter completing Sections I. Through VII. I certify under penlty of lw tht I hve personlly exmined nd m fmilir with the informtion submitted in this nd ll ttched documents, nd tht bsed on my inquiry of those individuls responsible for obtininq the informtion, I believe tht the submitted informtion is true, ccurte, nd complete. Nme & officil title of tnk opertor or uthorized representtive Dte Signed Pt Leon,rd, Wter Production Supervisor "-7/- Signtu;;'';;', J 3/;1/0 - Nme &6fficii'title of tflk Q!f11Jllor uthorized representtive Mike Schmitz, Myor Dte Signed SiQnture ADEM Form # 283 1/2010

10 Notifiction for Aboveground Storge Tnks FOR Return Albm Dept. of Environmentl Mngement STATE USE ONLY TANKS Completed Groundwter Brnch IN Form P. O. Box AL To Montgomery, AL 36130"1463 I. D. Number N01"IFI INSTRUCTIONS Plese type or print ll items except "signture' in Section XII. This form must be completed for ech loction contining boveground IIndicte number of continution sheets storge tnks. If more thn 5 tnks re owned t this loction, photocopy, nd stple continution sheets to this form. ttched I0 I I. OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) FcilityI.O.# - - Fcility Nme Wter Production Well #33 or Compny Site Identifier, s pplicble (Unless New Loction) Owner Nme City of Dothn (Corportion, Individul, Public Agency, or Other Entity) Miling Address 1?6 N. Sint Andrews Street City Dothn Stte AL Zip Contct Mike Schmitz, Myor Phone # (334) Fx# (334) E-mil myor@dothn.org Type of Owner Street 756 Wllce Drive County Rod, Highwy, or Stte Rod, s pplicble County Houston City Dothn StteAL Zip (Nerest) Contct Donnie Bedsole, Wter Production Chief O~ertor Phone # (334) Indicte number of boveground D Mrk box here if tnk(s) D storge tnks t this loction re locted on lnd within DStte Gov't DPtivte n Indin reservtion or DFederl Gov't IIILocl Gov't (GSA Fcility 1.0. No. ) III. OPERATOR OF TANKS Nme(lf sme s section I, mrk box here 0) Indicte number of underground ~ on other Indin trust lnds storge tnks t this loction IV. CONTACT PERSON AT TANK LOCATION Nme (If sme s section III, mrk box here [lh Pt Leonrd, Wter Production Su~ervisor Opertor Nme(Corportion, IndMdul, Public Agency, or Other Entity) Miling Address 200 Kilgore Drive City Dothn Stte AL Zip Contct Pt Leonrd Nme of Individul Job Title Phone Numbec~) Phone Number _<-334 ) V. TYPE OF NOTIFICATION If this is new notifiction for this loction, mrk box here III If this is n mended or subsequent notifiction for this loction, mrk box here [ ] VI. TRUST FUND ELIGIBILITY INFORMATION THE FOLLOWING IS REQUIRED TO BE ELIGIBLE FOR THE ALABAMA ABOVEGROUND STORAGE TANK TRUST FUND The tnk must be registered with the underground storge tnk section of ADEM. A copy of registrtion certificte is proof of registrtion. The tnk must contin motor fuel, nd not be excluded by the trust fund regultions. The tnk must be in substntil complince with the pplicble requirements below t the time of the discovery of the relese with the following (For informtion cll ADEM t (334) ). Spill Prevention Control & Countermesure (SPCC) pln prepred by registered professionl engineer. NPDES or SID stormwter permit. The relese must hve occurred fter August 1, The tnk cnnot be owned by the stte or federl government. ADEM Form # 283 1/2010 Issue Dte: 1996 CONTINUE ON NEXT PAGE I

11 Owner Nme City of Dothn Loction 611 Wllce Drive, Dothn, AL Pge No. 2 (from Section ij (from Section II) VI. DESCRlPllON OF ABOVEGROUND STORAGj TANKS (Com, lete for ech lnk t.his I..olionl Tnk Identifiction No. Arbitrrily Assigned Sequentil Number (e.g. l, 2, 3) Tnk No. Tnk No. Tnk No. Tnk No. A. Tnk Sttus (Mrk IIlhtpply) 1. CurrenUv in use x 2. Temporrily dosed. Estimted dte lst used (mooth/ver) 1 f b. Estimted Quntity of substnce remining (gllons) gl. gl. gl. gl. gl. 3.Permneotiydosed B. Tnk loction (Mrk ll thi pply) 1. Locted bove ground x. Within 300 feet of privte well b. Within 1000 feet of public wter supply well x c. Within well hed protection re x 2. locted in n underground re such s bsement, cellr. mineworklng. drift, shft, or tunnel. nd is situted upon or bove the floor surfce. {NOTIFICATION NOT REQUIRED} C. Tnk History 1. Dle instlled (mooth/dy/yer) i I I 1 1 I I I I I 2. Dte sold by this owner (month/dv/ver) I I I I 1 1 I f I I I 3. Dte bought by this owner (mooth/dy!yer) 1 1 I I I I I I I I D. Tnk Estimted Totl Cpcity (gllons) 3000 gl gl. gl. gl. gl E. SUbstnce Currently Stored (Mrk ll Iht ""ply) 1. Petroleum. Unleded gsoline b. Mid grede soline c. Premium gsoline d. Diesel Ix e. Kerosene f. Avition fuel (JP-4, etc.) g.usedoil h. Vimin oil i. E-85 i. B 2O Biodiesel k. Other. plese specify F. Tnk USQe (Mrk ll lhtpply) 1. Emerlleney power enertor x 2. Retil 3. Bulk fcility 4. Industril 5. locl (lovemment 6. StteJFederl government 7. Frm/residentil. Pipeline terminl lnk, refinery terminl tnk, ril nd heting oil (NOTIFICATION NOT REQUIRED) VIII. CERTIFICATION (Red nd sin fter completin Sections I. Throuh VII. I certify under penlty of lw tht I hve personlly exmined nd m fmilir with the informtion submitted In this nd ll ttched documents, nd tht bsed on my inquiry of those individuls responsible for obtining the informtion. I believe thl the submitted informtion is true, ccurte nd complete. Nme &officil due of tnk opertor or uthorized representtive Dte Signed Pt Leonrd, Wter Production Supervisor ~gnrure t;~rfif~j 3/1 1 5 Nme &officil tius of tnk owner or uthorized representtive Mike Schmitz, Myor Dte Signed Sinture ADEM Form # 283 1/2010

12 Dothn Utilities Aboveground Fuel Storge Tnk Cpcities Loctions Required to Meet the Spill Prevention. Control, nd Countermesure {SPCC) Regultion (Aboveground cpcity greter thn 1,320 gllons): Little Choctwhtchee WWfP (double wlj)-10,ooo gl Omussee Creek WWTP-4,OOO gl New Cypress Creek WWfP (double wll)-2,000 gl Well #31 (double wll)-2,30s gl Well #33 (double wll)-3,ooo gl Loctions Not Required to Meet the SPCC Regultion (Aboveground cpcity less thn 1,320 gllons}: Pettus Genertor-1,000 gl DU Genertor-109 gl Golf Creek l$-300 gl Portble Genertor Well # gl Pole Brn Fuel Tnk-SOO gl

13 Resolution No., execute the ADEM Notifiction for Aboveground Storge Tnks documents for the specified Dothn Utilities operting loctions, continued. Section 2. Tht Mike Schmitz, Myor of sid City of Dothn, nd in such cpcity, is hereby uthorized nd directed to execute sid documents for nd in the nme of the City of Dothn, Albm, which shll be ttested by the City Clerk. PASSED, ADOPTED AND APPROVED on ATTEST: Myor Associte Commissioner District 1 City Clerk Associte Commissioner District 2 Associte Commissioner District 3 Associte Commissioner District 4 Associte Commissioner District 5 Associte Commissioner District 6 BOARD OF CITY COMMISSIONERS