ADEM Form 440 "Petroleum Solvent Dry Cleaning Questionnaire" - Alabama

What Is ADEM Form 440?

This is a legal form that was released by the Alabama Department of Environmental Management - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2015;
  • The latest edition provided by the Alabama Department of Environmental Management;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of ADEM Form 440 by clicking the link below or browse more documents and templates provided by the Alabama Department of Environmental Management.

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Download ADEM Form 440 "Petroleum Solvent Dry Cleaning Questionnaire" - Alabama

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PETROLEUM SOLVENT DRY CLEANING QUESTIONNAIRE
1. Please list the following information in the chart below:
Dryer
Capacity (lbs)
Date of
Date of
Solvent
Unit Type
Unit
Installation
Manufacture
Recovery
(Dry-to-Dry
(Y/N)
or Transfer)
If additional space is needed, please list other dryers on separate page and submit with
this form.
2. Have any of these units been modified since their manufacture date? If so, which units have
been modified? Please give a brief description of the modifications.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
3. Which petroleum solvent(s) are used at this facility?
___________________________________________________________________________
___________________________________________________________________________
4. Are cartridge filters used in your solvent filtration system? If so, what are the procedures
used for disposal of spent cartridges?
___________________________________________________________________________
___________________________________________________________________________
5. Have there been any changes in ownership at this facility in the past 12 months? (Y/N) If so,
please indicate below:
__________________________________
________________________________
Name
Date
6.
___________________________ ________________________ ___________________
Name of Cleaning Facility
Mailing Address
City
Zip
_____________________________
_________________________________
County
Telephone Number
_________________________
________________________ ___________________
Facility Contact (Please Print)
Signature
Title
Please return to: ADEM-Air Division
PO Box 301463
Montgomery, AL 36130-1463
Attention: Jennifer Knight
ADEM Form 440 m1 7/2015
Page 1 of 1
PETROLEUM SOLVENT DRY CLEANING QUESTIONNAIRE
1. Please list the following information in the chart below:
Dryer
Capacity (lbs)
Date of
Date of
Solvent
Unit Type
Unit
Installation
Manufacture
Recovery
(Dry-to-Dry
(Y/N)
or Transfer)
If additional space is needed, please list other dryers on separate page and submit with
this form.
2. Have any of these units been modified since their manufacture date? If so, which units have
been modified? Please give a brief description of the modifications.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
3. Which petroleum solvent(s) are used at this facility?
___________________________________________________________________________
___________________________________________________________________________
4. Are cartridge filters used in your solvent filtration system? If so, what are the procedures
used for disposal of spent cartridges?
___________________________________________________________________________
___________________________________________________________________________
5. Have there been any changes in ownership at this facility in the past 12 months? (Y/N) If so,
please indicate below:
__________________________________
________________________________
Name
Date
6.
___________________________ ________________________ ___________________
Name of Cleaning Facility
Mailing Address
City
Zip
_____________________________
_________________________________
County
Telephone Number
_________________________
________________________ ___________________
Facility Contact (Please Print)
Signature
Title
Please return to: ADEM-Air Division
PO Box 301463
Montgomery, AL 36130-1463
Attention: Jennifer Knight
ADEM Form 440 m1 7/2015
Page 1 of 1