UST Forms

	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
UST-72	Agreement for Land Application or Containment and Treatment of Soils Containing Petroleum Products on Private Lands

	Permits and Inspection	Revision Date
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	10/2015
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	10/2015
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	9/2017
UST-22C	Annual Sump Visual Inspections	5/2018
UST-23A	Triennial UST Spill Bucket Integrity Testing	4/2018
UST-23B	Triennial UST Containment Sump/UDC Integrity Testing	9/2017
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	2/2018

	Permits and Inspection - Installation Forms	Revision Date
	Instructions for Completing UST-6 Application to Install or Replace USTs	8/2017
UST-6	Application to Install or Replace USTs (Pre/Post-Install)	8/2018
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)	4/2018
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)	9/2017
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	8/2017

	Financial Responsibility	Revision Date
	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 01/09A )	1/2009
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