Forms: Division of Environmental Response and Remediation

Division Forms

• PST Remediation Site Eligibility Application (78 KB)
  (02/2017)—Application for PST fund eligibility.
• Request for Payment Voucher: PDF (28 KB)
  (07/07/12)
• Request for Public Information (GRAMA) (71 KB)
  Government Records Access and Management Act.
• Work Plan Application and Agreement Form: DOC (26 KB)
  (02/2005)

CERCLA Forms

• Decontamination Specialist Certification Program Initial Application
• Decontamination Specialist Certification Program
  Renewal Application
• DERR Targeted Brownfields Assessment Application (30 KB)
• Voluntary Cleanup Program Application (32 KB)

Underground Storage Tank Forms

• Assessment Grant Funding: Site Qualification for Assessment Grant Funding
• Notification of Ownership Change for Underground Storage Tanks
• Notification Form: EPA Form 7530-1 (2015)
• PST Loan Fund Application
• UST Operator Inspection Form

Cathodic Protection System Evaluation Forms

• Galvanic (Sacrificial Anode) Cathodic Protection
• Impressed Current Cathodic Protection

Certificate of Compliance Instructions and Forms

• Certificate of Compliance Application Form:DOC (24 KB)
  (07/2013)
• Certificate of Compliance Packet
  • Instructions and Forms (110 KB) (09/2017)
• Previous Pollution Incidents Form:DOC (21 KB)
  (09/2017)

Certification Applications

• Certification Program Forms
• Submit Applications and Payments Online

All applications submitted must be accompanied by the documentation and fees outlined by the eligibility requirements for certification.

• Groundwater and Soil Sampler Application (9 KB)
• UST Installer Application (12 KB)
• UST Remover Application (12 KB)
• UST Tester Application (11 KB)
• UST Inspector Application
• Initial Certified Consultants Application (15 KB)
• Renewal Certified Consultants Application (9 KB)

Closure Forms

• Temporary Closure
  (12/2005)—Must be filed if a tank is out of use for over three months.
• Closure Plan Requirements
  Instructions for a permanent closure of an underground storage tank.
• Closure Plan
  (07/2013)—For permanent closure of an underground storage tank.
• Closure Notice
  (02/01/2015)—Must be filed within three months or 90 days of permanent tank closure.

Installation Forms

Underground Storage Tank Installation Notification Form
(04/06/2020)—For all new UST installations (fee required) as well as upgrades and repairs to existing UST systems (no fee required). Submit this form with any applicable fee at least 10 days prior to performing the work.

Comments and Questions

All questions and comments may be directed to David Wilson ([email protected]).