UST Forms
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| Corrective Action | DOC | ||
| UST-61 | 24-Hour Release and UST Leak Reporting Form |  |
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| UST-62 | 24-Hour Notification of Discharge Form | |
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| Instructions and Form for Notice of Residual Petroleum |  |
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| Instructions and Form for Notice of Residual Petroleum with Alternate Land Use Restriction | |
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| Instructions and Form for Notice of Contaminated Site | |
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| VPH and EPH Laboratory Reporting Forms | |
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| Soil Permitting | |||
| UST-59 | Groundwater Quality Monitoring Compliance Report Form | |
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| UST-70 | Non-Discharge Permit Application for Soil Remediation Projects | |
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| UST-71 | Certificate of Approval for Storage/Treatment of Soil Containing Petroleum Products | UST-71 | |
| UST-72 | Agreement for Land Application or Containment and Treatment of Soils Containing Petroleum Products on Private Lands | |
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| Permits and Inspection | Revision Date | DOC | ||
| UST-2A | Site Investigation Report for Permanent Closure or Change-In-Service - REGISTERED TANKS | 1/2016 | |
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| UST-2B | Site Investigation Report for Permanent Closure or Change-In-Service - UNREGISTERED TANKS | 1/2016 | |
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| UST-3 | Notice of Intent: UST Permanent Closure or Change-In-Service | 6/2022 | |
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| UST-6 | See Table below for UST-6 Installation Forms | |||
| UST-7A | Cathodic Protection Testing form for galvanic cathodic protection systems | 1/2020 | |
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| UST-7B | Cathodic Protection Testing form for impressed current cathodic protection systems | 1/2020 | |
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| UST-8 | Notification for Activities Involving Underground Storage Tanks | 3/2018 | |
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| UST-12 | Closure Report Format | 8/2008 | |
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| UST-15 | Change of Ownership of UST System(s) | 2/2018 | |
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| UST-15A | Ownership of UST Systems | 2/2018 | |
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| UST-16 | Manual Tank Gauging Record | 5/2018 | |
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| UST-17A | UST Suspected Release 24 Hour Notice Form | 10/2018 | |
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| UST-17B | UST Suspected Release 7 Day Notice Form | 10/2015 | |
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| UST-18 | Application for Tax Certification | 10/2015 | |
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| UST-19 | Certification of Leak Detection Exemption for Suction Piping Associated with USTs | 3/2018 | |
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| UST-20 | Alternative Fuel/Hazardous Substance Compatibility Checklist | 10/2015 | |
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| UST-21 | Impressed Current Cathodic Protection System 60-Day Record of Rectifier Operation | 1/2020 | |
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| UST-22A | Overfill Prevention Equipment Operability Check (Instructions) | 11/2022 | |
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| UST-22B | Annual Leak Detection Equipment Operability Check | 11/2022 | |
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| UST-22C | Annual Sump Visual Inspections | 12/2022 | |
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| UST-23A | Triennial UST Spill Bucket Integrity Testing | 11/2022 | |
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| UST-23B |
Triennial UST Containment Sump/UDC Integrity Testing |
5/2020 | |
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| UST-23C | Triennial UST Piping Integrity Testing | 11/2022 | |
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| UST-23D | Triennial UST Interstice Integrity Testing | 11/2022 | |
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| UST-24 | Certification of No Visible Corrosion on Metallic Piping Components | 10/2015 | |
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| UST-27 | Monthly Walkthrough Inspections | 11/2022 | |
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| 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.
| Trust Fund | Revision Date | DOC | |
| State Cleanup Funds | |||
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Eligibility Forms |
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| Changes effective 3/1/08 Memo | 3/2008 | |
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| Eligibility Flowchart | 10/2016 | |
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| Memo Eligibility Application Form 01/09 | 1/2009 | |
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| Eligibility Application Form (rev 5/26/2021) | 5/2021 | |
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| Extra Tank Data Worksheet | 2/2008 | |
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| Extra Corrosion Protection & Spill Overflow worksheet | 2/2008 | |
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| Reasonable Rate Documents | |||
| 98 & 03 Reasonable Rates | |||
| Federal Cleanup Funds | |||
| Financial Data Request Form | 1/2004 | |
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