UST Forms
Note: Some PDFs are dynamic fillable forms with functionality to add/remove pages in the document that do not open with MS Edge or Chromes PDF plugin. To open those forms using MS Edge or Chrome you will need to use your local PDF reader installed on your computer (e.g Adobe Reader). For instructions on how to change Chromes settings to open these forms click here. For instructions for MS Edge click here.
| Corrective Action | Word Document | ||
| UST-61 | 24-Hour Release and UST Leak Reporting Form | ||
| UST-62 | 24-Hour Notification of Discharge Form | ||
| Instructions and Form for Notice of Residual Petroleum (UST Releases) | WORD | ||
| Instructions and Form for Notice of Residual Petroleum with Alternate Land Use Restriction (UST Releases) | WORD | ||
| Instructions and Form for Notice of Residual Petroleum (AST or other non-UST Releases) | WORD | ||
| Instructions and Form for Notice of Contaminated Site | WORD | ||
| VPH and EPH Laboratory Reporting Forms | WORD | ||
| Soil Permitting | |||
| UST-59 | Groundwater Quality Monitoring Compliance Report Form | ||
| UST-59A | Compliance Report Form | ||
| UST-70 | Non-Discharge Permit Application for Soil Remediation Projects | WORD | |
| UST-71 | Certificate of Approval for Storage/Treatment of Soil Containing Petroleum Products | WORD | |
| UST-72 | Agreement for Land Application or Containment and Treatment of Soils Containing Petroleum Products on Private Lands | WORD | |
| Soil Acceptance Form |
Note: Some PDFs are dynamic fillable forms with functionality to add/remove pages in the document that do not open with MS Edge or Chromes PDF plugin. To open those forms using MS Edge or Chrome you will need to use your local PDF reader installed on your computer (e.g Adobe Reader). For instructions on how to change Chromes settings to open these forms click here. For instructions for MS Edge click here.
| Permits and Inspection | Revision Date | Word Document | ||
| UST-2A | Site Investigation Report for Permanent Closure or Change-In-Service - REGISTERED TANKS | 1/2016 | WORD | |
| UST-2B | Site Investigation Report for Permanent Closure or Change-In-Service - UNREGISTERED TANKS | 1/2016 | WORD | |
| UST-3 | Notice of Intent: UST Permanent Closure or Change-In-Service | 8/2023 | WORD | |
| UST-6 | See next table below for UST-6 Installation Forms | |||
| UST-7A | Cathodic Protection Testing form for galvanic cathodic protection systems | 1/2020 | WORD | |
| Dynamic PDF | ||||
| UST-7B | Cathodic Protection Testing form for impressed current cathodic protection systems | 1/2020 | WORD | |
| Dynamic PDF | ||||
| UST-8 | Notification for Activities Involving Underground Storage Tanks | 3/2018 | WORD | |
| UST-12 | Closure Report Format (see Comprehensive Appendices for Corrective Action Guidelines ) | 6/21/2023 | WORD | |
| UST-15 | Change of Ownership of UST System(s) | 2/2018 | WORD | |
| UST-15A | Ownership of UST Systems | 2/2018 | WORD | |
| UST-16 | Manual Tank Gauging Record | 5/2018 | ||
| UST-17A | UST Suspected Release 24 Hour Notice Form | 10/2018 | WORD | |
| UST-17B | UST Suspected Release 7 Day Notice Form | 10/2015 | WORD | |
| UST-18 | Application for Tax Certification | 10/2015 | WORD | |
| UST-19 | Certification of Leak Detection Exemption for Suction Piping Associated with USTs | 3/2018 | WORD | |
| UST-20 | Alternative Fuel/Hazardous Substance Compatibility Checklist | 10/2015 | WORD | |
| UST-21 | Impressed Current Cathodic Protection System 60-Day Record of Rectifier Operation | 1/2020 | WORD | |
| UST-22A | Overfill Prevention Equipment Operability Check (Instructions) | 11/2022 | WORD | |
| Dynamic PDF | ||||
| UST-22B | Annual Leak Detection Equipment Operability Check | 11/2022 | WORD | |
| Dynamic PDF | ||||
| UST-22C | Annual Sump Visual Inspections | 7/2024 | WORD | |
| Dynamic PDF | ||||
| UST-23A | Triennial UST Spill Bucket Integrity Testing | 11/2022 | WORD | |
| Dynamic PDF | ||||
| UST-23B | Triennial UST Containment Sump/UDC Integrity Testing | 5/2020 | WORD | |
| Dynamic PDF | ||||
| UST-23C | Triennial UST Piping Integrity Testing | 11/2022 | WORD | |
| UST-23D | Triennial UST Interstice Integrity Testing | 11/2022 | WORD | |
| UST-24 | Certification of No Visible Corrosion on Metallic Piping Components | 10/2015 | WORD | |
| UST-27 | Monthly Walkthrough Inspections | 11/2022 | WORD | |
| Dynamic PDF |
CNote: Some PDFs are dynamic fillable forms with functionality to add/remove pages in the document that do not open with MS Edge or Chromes PDF plugin. To open those forms using MS Edge or Chrome you will need to use your local PDF reader installed on your computer (e.g Adobe Reader). For instructions on how to change Chromes settings to open these forms click here. For instructions for MS Edge click here.
| Permits and Inspection - Installation Forms | Revision Date | Word Document | ||
| Instructions for Completing UST-6 Application to Install or Replace USTs | 2/2025 | |||
| UST-6 | Application to Install or Replace USTs (Pre/Post-Install) | 12/2023 | WORD | |
| Dynamic PDF | ||||
| UST-6C | Application to Install or Replace USTs (Schedule of Materials) | 10/2015 | WORD | |
| UST-6D | Application to Install or Replace USTs (UST Spill Bucket Testing) | 11/2022 | WORD | |
| Dynamic PDF | ||||
| UST-6E | Application to Install or Replace USTs (Tank Installation Testing) | 11/2022 | WORD | |
| UST-6F | Application to Install or Replace USTs (Containment Sump/UDC Testing) | 5/2020 | WORD | |
| Dynamic PDF | ||||
| UST-6H | Application to Install or Replace USTs (Post-Installation Piping Integrity Testing) | 11/2022 | WORD | |
| UST-6-TOPR | UST Post-Installation – Temporary Operating Permit Request Due to the increased volume of applications and to avoid duplication of work the 30-Day temporary operating permit (TOPR) is currently not available. A complete UST-6 (Post-Installation) package must be submitted to the NCDEQ-UST Section as soon as possible to allow adequate time for a complete review of the documentation and the issuance of a full UST-Permit in a timely manner. | |||
| UST Permit Application | Revision Date | |
| Compliance Questionnaire | 3/2020 |
Note: Some PDFs are dynamic fillable forms with functionality to add/remove pages in the document that do not open with MS Edge or Chromes PDF plugin. To open those forms using MS Edge or Chrome you will need to use your local PDF reader installed on your computer (e.g Adobe Reader). For instructions on how to change Chromes settings to open these forms click here.
| Financial Responsibility | Revision Date | Word Document | ||
| Chief Financial Officer Letter | 11/2005 | |||
| UST-FR1 | Certificate of Insurance (UST-FR1) | 10/2015 | WORD | |
| Certificate of Financial Responsibility | 10/2015 | |||
| Worksheet for Required Amount of Financial Assurance |
| Trust Fund | Revision Date | Word Document | |
| State Cleanup Funds | |||
| Eligibility Forms IMPORTANT NOTICE FOR NONCOMMERCIAL FUND CLAIMANTS AND CONSULTANTS/CONTRACTORS - Click here | |||
| Changes effective 3/1/08 Memo | 3/2008 | WORD | |
| Eligibility Flowchart | 10/2016 | ||
| Memo Eligibility Application Form 01/09 | 1/2009 | WORD | |
| Eligibility Application Form (rev 5/26/2021) | 5/2021 | WORD | |
| Extra Tank Data Worksheet | 2/2008 | WORD | |
| Extra Corrosion Protection & Spill Overflow worksheet | 2/2008 | WORD | |
| Reasonable Rate Documents | |||
| 98 & 03 Reasonable Rates | |||
| Federal Cleanup Funds | |||
| Financial Data Request Form | 1/2004 | ||