UST Forms

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	Corrective Action		PDF	DOC
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
	Instructions and Form for Notice of Residual Petroleum with Alternate Land Use Restriction
	Instructions and Form for Notice of Contaminated Site
	VPH and EPH Laboratory Reporting Forms
Soil Permitting
UST-59	Groundwater Quality Monitoring Compliance Report Form
UST-70	Non-Discharge Permit Application for Soil Remediation Projects
UST-71	Certificate of Approval for Storage/Treatment of Soil Containing Petroleum Products
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	PDF	DOC
UST-2A	Site Investigation Report for Permanent Closure or Change-In-Service - REGISTERED TANKS	1/2016
UST-2B	Site Investigation Report for Permanent Closure or Change-In-Service - UNREGISTERED TANKS	1/2016
UST-3	Notice of Intent: UST Permanent Closure or Change-In-Service	2/2021
UST-6	See Table below for UST-6 Installation Forms
UST-7A	Cathodic Protection Testing form for galvanic cathodic protection systems	1/2020
			PDF with Add/Remove page buttons
UST-7B	Cathodic Protection Testing form for impressed current cathodic protection systems	1/2020
			PDF with Add/Remove page buttons
UST-8	Notification for Activities Involving Underground Storage Tanks	3/2018
UST-12	Closure Report Format	8/2008
UST-15	Change of Ownership of UST System(s)	2/2018
UST-15A	Ownership of UST Systems	2/2018
UST-16	Manual Tank Gauging Record	5/2018
UST-17A	UST Suspected Release 24 Hour Notice Form	10/2018
UST-17B	UST Suspected Release 7 Day Notice Form	10/2015
UST-18	Application for Tax Certification	10/2015
UST-19	Certification of Leak Detection Exemption for Suction Piping Associated with USTs	3/2018
UST-20	Alternative Fuel/Hazardous Substance Compatibility Checklist	10/2015
UST-21	Impressed Current Cathodic Protection System 60-Day Record of Rectifier Operation	1/2020
UST-22A	Overfill Prevention Equipment Operability Check (Instructions)	5/2020
			PDF with Add/Remove page buttons
UST-22B	Annual Leak Detection Equipment Operability Check	12/2020
			PDF with Add/Remove page buttons
UST-22C	Annual Sump Visual Inspections	9/2020
			PDF with Add/Remove page buttons
UST-23A	Triennial UST Spill Bucket Integrity Testing	5/2020
			PDF with Add/Remove page buttons
UST-23B	Triennial UST Containment Sump/UDC Integrity Testing Low-Level Hydrostatic Sump Testing Procedures	5/2020
			PDF with Add/Remove page buttons
UST-23C	Triennial UST Piping Integrity Testing	10/2015
UST-23D	Triennial UST Interstice Integrity Testing	5/2021
UST-24	Certification of No Visible Corrosion on Metallic Piping Components	10/2015
UST-27	Monthly Walkthrough Inspections	5/2021
			PDF with Add/Remove page buttons

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	Permits and Inspection - Installation Forms	Revision Date	PDF	DOC
	Instructions for Completing UST-6 Application to Install or Replace USTs	1/2019
UST-6	Application to Install or Replace USTs (Pre/Post-Install)	3/2021
			PDF with Add/Remove page buttons
UST-6C	Application to Install or Replace USTs (Schedule of Materials)	10/2015
UST-6D	Application to Install or Replace USTs (UST Spill Bucket Testing)	5/2020
			PDF with Add/Remove page buttons
UST-6E	Application to Install or Replace USTs (Tank Installation Testing)	5/2021
UST-6F	Application to Install or Replace USTs (Containment Sump/UDC Testing)	5/2020
			PDF with Add/Remove page buttons
UST-6G	Application to Install or Replace USTs (Pre-Installation Piping Integrity Testing	10/2015
UST-6H	Application to Install or Replace USTs (Post-Installation Piping Integrity Testing)	10/2015
UST-6-TOPR	UST Post-Installation – Temporary Operating Permit Request	1/2019

UST Permit Application	Revision Date	PDF
Compliance Questionnaire	3/2020

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	Financial Responsibility	Revision Date	PDF	DOC
	Chief Financial Officer Letter	11/2005
UST-FR1	Certificate of Insurance (UST-FR1)	10/2015
	Certificate of Financial Responsibility	10/2015
	Worksheet for Required Amount of Financial Assurance

Trust Fund	Revision Date	PDF	DOC
State Cleanup Funds
Eligibility Forms IMPORTANT NOTICE FOR NONCOMMERCIAL FUND CLAIMANTS AND CONSULTANTS/CONTRACTORS - Click here
Changes effective 3/1/08 Memo	3/2008
Eligibility Flowchart	10/2016
Memo Eligibility Application Form 01/09	1/2009
Eligibility Application Form (rev 5/26/2021)	5/2021
Extra Tank Data Worksheet	2/2008
Extra Corrosion Protection & Spill Overflow worksheet	2/2008
Reasonable Rate Documents
98 & 03 Reasonable Rates
Federal Cleanup Funds
Financial Data Request Form	1/2004