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    
         
  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   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 5/2019
UST-6 See Table below for UST-6 Installation Forms      
UST-7A Cathodic Protection Testing form for galvanic cathodic protection systems 10/2015
UST-7B Cathodic Protection Testing form for impressed current cathodic protection systems 10/2015
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 10/2015
UST-22A Overfill Prevention Equipment Operability Check (Instructions) 7/2018
UST-22B Annual Leak Detection Equipment Operability Check 2/2019
UST-22C Annual Sump Visual Inspections 5/2018
UST-23A Triennial UST Spill Bucket Integrity Testing 3/2019
UST-23B

Triennial UST Containment Sump/UDC Integrity Testing

Low-Level Hydrostatic Sump Testing Procedures

 3/2019
UST-23C Triennial UST Piping Integrity Testing 10/2015
UST-23D Triennial UST Interstice Integrity Testing 10/2015
UST-24 Certification of No Visible Corrosion on Metallic Piping Components 10/2015
UST-27 Monthly Walkthrough Inspections 7/2019

 

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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) 1/2019
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) 3/2019
UST-6E Application to Install or Replace USTs (Tank Installation Testing) 10/2015
UST-6F Application to Install or Replace USTs (Containment Sump/UDC Testing) 3/2019
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 7/2019

 

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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 08/01/2019) 8/2019  
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  

 

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