FORM R REPORTS

Reference Point/Description	Latitude	Longitude	Collection Method	Accuracy Value
N/A	38.294444	-75.625	N/A	N/A

RCRA ID NUMBER
MDD095415840

NPDES PERMIT NUMBER
NO DATA

UIC ID NUMBER
NO DATA

To correct the FRS latitude, longitude or program ID values click on the "Report an Error" button in the top right corner of this page. Facilities wishing to correct other data elements with the FORM R or FORM A should refer to the related TRI-MEweb tutorial..

For more information, see Collection of Latitude, Longitude and Program ID Data Has Been Discontinued.

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PART I. FACILITY IDENTIFICATION INFORMATION (FORM A)

DOCUMENT CONTROL NUMBER: 1321219445374

Facility Registry System ID:  110000340667

Section 1. Reporting Year

Reporting Year: 2021

Section 2. Trade Secret Information

2.1 Trade Secret: NO

2.2 Sanitized Copy: Unsanitized

Section 3. Certification

CERTIFYING OFFICIAL'S NAME	CERTIFYING OFFICIAL'S TITLE	CERTIFYING OFFICIAL'S SIGNATURE	DATE SIGNED
JOSH ADKINS	EHS DIRECTOR	Electronic	31-JAN-22

Section 4. Facility Identification

TRI Facility ID: 21826TLNTCEDENR

4.1 Facility Name and Address.

Facility Information

NAME	STREET	CITY	COUNTY	STATE	ZIP CODE
CULPEPER OF FRUITLAND LLC	28114 OLD EDEN RD	EDEN	WICOMICO	MD	21822

BIA Tribal Code	Tribe
NO DATA	NO DATA

Mailing Information

NAME	STREET	CITY	STATE	ZIP CODE
CULPEPER OF FRUITLAND LLC	PO BOX 208	FRUITLAND	MD	21826

PROVINCE	COUNTRY (NON - US)
NO DATA	NO DATA

4.2 Facility Classification

ENTIRE FACILITY	PARTIAL FACILITY	FEDERAL FACILITY	GOCO FACILITY
YES	NO	NO	NO

4.3 Technical Contact

Not Available to the Public as this information is only for Intranet.

4.4 Public Contact

NAME	PHONE
ANDY WEGT	4105736880

4.5 NAICS Codes

NAICS CODE	PRIMARY	NAICS CODE DESCRIPTION
321114	YES	Wood Preservation

4.7 Dun Numbers

DUNS NUMBER
NA

5. Parent Company Information

Parent Company Name: No US Parent Company

Parent Company DUNS Number:

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PART II. CHEMICAL - SPECIFIC INFORMATION

DOCUMENT CONTROL NUMBER: 1321219445374

Section 1. Toxic Chemical Identity

1.1 CAS Number: N020

1.2 Toxic Chemical or Chemical Category Name: Arsenic compounds

1.3 Generic Chemical Name: NA

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PART I. FACILITY IDENTIFICATION INFORMATION (FORM A)

DOCUMENT CONTROL NUMBER: 1321219445386

Facility Registry System ID:  110000340667

Section 1. Reporting Year

Reporting Year: 2021

Section 2. Trade Secret Information

2.1 Trade Secret: NO

2.2 Sanitized Copy: Unsanitized

Section 3. Certification

CERTIFYING OFFICIAL'S NAME	CERTIFYING OFFICIAL'S TITLE	CERTIFYING OFFICIAL'S SIGNATURE	DATE SIGNED
JOSH ADKINS	EHS DIRECTOR	Electronic	31-JAN-22

Section 4. Facility Identification

TRI Facility ID: 21826TLNTCEDENR

4.1 Facility Name and Address.

Facility Information

NAME	STREET	CITY	COUNTY	STATE	ZIP CODE
CULPEPER OF FRUITLAND LLC	28114 OLD EDEN RD	EDEN	WICOMICO	MD	21822

BIA Tribal Code	Tribe
NO DATA	NO DATA

Mailing Information

NAME	STREET	CITY	STATE	ZIP CODE
CULPEPER OF FRUITLAND LLC	PO BOX 208	FRUITLAND	MD	21826

PROVINCE	COUNTRY (NON - US)
NO DATA	NO DATA

4.2 Facility Classification

ENTIRE FACILITY	PARTIAL FACILITY	FEDERAL FACILITY	GOCO FACILITY
YES	NO	NO	NO

4.3 Technical Contact

Not Available to the Public as this information is only for Intranet.

4.4 Public Contact

NAME	PHONE
ANDY WEGT	4105736880

4.5 NAICS Codes

NAICS CODE	PRIMARY	NAICS CODE DESCRIPTION
321114	YES	Wood Preservation

4.7 Dun Numbers

DUNS NUMBER
NA

5. Parent Company Information

Parent Company Name: No US Parent Company

Parent Company DUNS Number:

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PART II. CHEMICAL - SPECIFIC INFORMATION

DOCUMENT CONTROL NUMBER: 1321219445386

Section 1. Toxic Chemical Identity

1.1 CAS Number: N090

1.2 Toxic Chemical or Chemical Category Name: Chromium compounds (except for chromite ore mined in the Transvaal Region)

1.3 Generic Chemical Name: NA

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PART I. FACILITY IDENTIFICATION INFORMATION (FORM A)

DOCUMENT CONTROL NUMBER: 1321219445398

Facility Registry System ID:  110000340667

Section 1. Reporting Year

Reporting Year: 2021

Section 2. Trade Secret Information

2.1 Trade Secret: NO

2.2 Sanitized Copy: Unsanitized

Section 3. Certification

CERTIFYING OFFICIAL'S NAME	CERTIFYING OFFICIAL'S TITLE	CERTIFYING OFFICIAL'S SIGNATURE	DATE SIGNED
JOSH ADKINS	EHS DIRECTOR	Electronic	31-JAN-22

Section 4. Facility Identification

TRI Facility ID: 21826TLNTCEDENR

4.1 Facility Name and Address.

Facility Information

NAME	STREET	CITY	COUNTY	STATE	ZIP CODE
CULPEPER OF FRUITLAND LLC	28114 OLD EDEN RD	EDEN	WICOMICO	MD	21822

BIA Tribal Code	Tribe
NO DATA	NO DATA

Mailing Information

NAME	STREET	CITY	STATE	ZIP CODE
CULPEPER OF FRUITLAND LLC	PO BOX 208	FRUITLAND	MD	21826

PROVINCE	COUNTRY (NON - US)
NO DATA	NO DATA

4.2 Facility Classification

ENTIRE FACILITY	PARTIAL FACILITY	FEDERAL FACILITY	GOCO FACILITY
YES	NO	NO	NO

4.3 Technical Contact

Not Available to the Public as this information is only for Intranet.

4.4 Public Contact

NAME	PHONE
ANDY WEGT	4105736880

4.5 NAICS Codes

NAICS CODE	PRIMARY	NAICS CODE DESCRIPTION
321114	YES	Wood Preservation

4.7 Dun Numbers

DUNS NUMBER
NA

5. Parent Company Information

Parent Company Name: No US Parent Company

Parent Company DUNS Number:

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PART II. CHEMICAL - SPECIFIC INFORMATION

DOCUMENT CONTROL NUMBER: 1321219445398

Section 1. Toxic Chemical Identity

1.1 CAS Number: N100

1.2 Toxic Chemical or Chemical Category Name: Copper compounds

1.3 Generic Chemical Name: NA

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