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    
  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 3/2020
UST-6 See Table below for UST-6 Installation Forms      
UST-7A Cathodic Protection Testing form for galvanic cathodic protection systems 1/2020
UST-7B Cathodic Protection Testing form for impressed current cathodic protection systems 1/2020
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) 7/2018
UST-22B Annual Leak Detection Equipment Operability Check 1/2020
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 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 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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