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Al Management Groundwater Branch/UST Compliance Unit Post Office Box 301463 Montgomery, Alabama 36130-1463 Or fax the completed form within 30 days of transferring ownership to: (334) 270-5631 Any questions concerning the completion of this form, call the Groundwater Branch at (334) 270-5655 FACILITY INFORMATION Former Name of Facility: New Name of Facility: Location (street or highway): City, County: ADEM Facility I.D. Number: No. of UST s included in transfer: No. of AST s included in.

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