Alabama Department of Environmental Management
Deactivation Request Form for e-DMR/e-SSO
This form should be used to deactivate a Permittee's registration in ADEM's E2 Reporting System if the Permittee is no longer able or does not desire to
continue to operate as an E2 Reporting System Permittee as described in the ADEM E2 Reporting System Permittee Participation Package. (Please note, this
form is not for deleting individual E2 User Accounts. To delete an individual E2 User Account, please complete and submit an ADEM Form 511: Permittee
Registration Form for e-DMR/e-SSO.) A Permittee may not deactivate its registration in ADEM's E2 Reporting System if it holds a permit that requires
participation. Please review ADEM's E2 Reporting System Permittee Participation Package should you have any questions about completing this form. It is
available on ADEM's website at https://e2.adem.alabama.gov/NPDES. Please send a hard copy of the completed form with original wet-ink signature to:
ADEM
Attn: E2 Coordinator
P O Box 301463
Montgomery, AL 36130-1463
1a. Facility ID:
1b. Facility Name:
2. Permittee Name:
3. Mailing Address (Line 1):
4. Mailing Address (Line 2):
5. Mailing Address (City, State, Zip):
Note: The Facility ID can be located by clicking on "Associated Facilities" when logged into a Permittee's representative's E2 User Account.
8. Requested Deactivation Date:
Note: Unless prearranged with the E2 Reporting System Coordinator, please allow 30 days for processing.
7. eMail Address:6. Office Phone No.:
Page 1 of 1
ADEM Form 513
I request that the registration for the above identified Permittee's facility be deactivated in ADEM's E2 Reporting System. I certify that the Permittee does
not currently hold any permits for this facility that require participation in ADEM's E2 Reporting System.
I understand that the Permittee is obligated to continue to use the E2 Reporting System to conclude any unfinished business (submitting or correcting
reports) that involves reporting requirements during the time frame in which the Permittee was an active E2 Reporting System Permittee.
I understand that this request in no way changes the reporting requirements of the Permittee, and that the Permittee must continue to submit all DMR and/or
SSO reports. This request is only an indication that the Permittee will no longer use the ADEM E2 Reporting System.
I certify under penalty of law that I have personally examined and am familiar with the information submitted in this application and all attachments and
that, based on my inquiry of those persons immediately responsible for obtaining the information contained in the application, I believe that the information
is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and
imprisonment.
Name of Responsible Official or Duly Authorized Representative
(Type or print legibly)
Official Title
(Type or print legibly)
Date Signed
Signature
Note: This form may only be signed by a Responsible Official (RO) or Duly Authorized Representative (DAR), as specified in the ADEM Admin. Code.
For ADEM Use Only
Received By:
Date
Deactivation :
Name Date
Approved By:
E2 Updated:
