Division Forms Pages
- Air Quality Forms
Includes complaint forms, emission inventory submittal forms and instructions, HAPS, asbestos, and other commonly requested forms. - Drinking Water Forms
Includes capacity, construction, certification, sanitary survey, disinfection, financial assistance, groundwater, operator and other drinking water related forms. - Environmental Response and Remediation Forms
Includes petroleum storage tank, underground storage tank, and other CERCLA and superfund related forms. - Waste Management and Radiation Control
Includes regulated activities, small business assistance, annual report, registration, application, financial assurance, and other waste related forms. Also includes generator site access, x-ray, and other general radiation control forms. - Water Quality Forms
Includes UPDES, funding assistance, ground water discharge, storm water, UIC, wastewater, and other certification forms and applications.
Forms by Title
A
- Abatement Project Notification: Lead-Based Paint
- Alternative Work Practice Form (Asbestos)
- Asbestos Renovation/Abatement Notification Form
- Application for Course Accreditation: Lead-Based Paint
- Application for Used Oil Collection Center
- Application Form: Financial Assistance: Drinking Water
- Application Form: Mammography Physicists
- Arsenic Exemption Worksheet
- Asbestos Alternative Work Practice Request Form
- Asbestos Company Certification Application
- Asbestos Emergency Renovation/Abatement or Ordered Notification Form
- Asbestos Individual Certification Application Form
- Asbestos Renovation/Abatement Forms
- Asbestos of Lead-Based Paint Requirements for Certifications
- Asbestos Pre-Ratenovion Form
- Assessment Grant Funding
- Attachment C:List of Hazardous Air Pollutants (Small Source Exemption; Air Quality)
- Attachment D: Wood Finisher Worksheet (Small Source Exemption; Air Quality)
- Attachment E: Printer Worksheet (Small Source Exemption; Air Quality)
- Attachment F: Auto Body Refinisher Worksheet (Small Source Exemption; Air Quality)
B
- N/A
C
- Capacity Assessment Worksheets
- Certificate of Compliance Application Form (DERR):
- Certification Application for Firms: Lead-Based Paint
- Certification Application for Individuals: Lead-Based Paint
- Certificate of Compliance Packet (DERR)
- Certification Form for All Companies (Asbestos)
- Certification Program Forms (DERR)
- Citizenship Certification: Senate Bill 81
- Citizenship Certification: Water Quality
- Citizenship Certification Form (Asbestos and Lead-based Paint)
- Class I Non-Hazardous Injection Well Permit Application Package
- Class III Permit Application Package for Solution Mining of Salts or Potash
- Class V Authorized-By-Rule Change of Operating Status Form
- Class V General Permit Application Package
- Class V Permit Application Package for Aquifer Storage and Recovery
- Closure Notice (UST):
- Closure Plan (UST):
- Compost Facility Annual Report Form: Solid and Hazardous Waste:
- Consumer Notice Lead and Cooper Water Sample Results:
- Continuing Education Unit (CEU) Individual Application: Drinking Water
- Copper Sampling Summary Sheet
D
- Data Locations Form: Drinking Water
- Decontamination Specialist Certification Program Initial Application (CERCLA)
- Decontamination Specialist Certification Program Renewal Application (CERCLA)
- Deficiency Reporting Form: Drinking Water:
- Demolition Projects with No Asbestos Removal
- Disinfection Profiler Spreadsheet: Water Treatment Facilities
- DWMRC-01 Radioactive Material License Application
- DWMRC-02A (AMP): Preceptor Attestations for Medical Use
- DWMRC-02A (ANP): Preceptor Attestations for Medical Use
- DWMRC-02A (AUD): Preceptor Attestations for Medical Use
- DWMRC-02A (AUS): Preceptor Attestations for Medical Use
- DWMRC-02A (AUT): Preceptor Attestations for Medical Use
- DWMRC-02A (RSO): Preceptor Attestations for Medical Use
- DWMRC-04: Notice to Employees
- DWMRC-04SP: Aviso a los Empleadon
- DWMRC-05: Cumulative Occupational Exposure History
- DWMRC-06: Occupational Exposure Record
- DWMRC-07: In Vitro Testing under General License—Registration Form
- DWMRC-10: X-ray Machine Registration Application
- DWMRC-12: Use of Depleted Uranium—Registration Form
- DWMRC-13: Certain Measuring, Gauging or Controlling Devices Under General License—Registration Form
- DWMRC-14: Radioactive Material License Termination
- DWMRC-26: Generator Site Access Permit Application
- Dust Control Plan Form (Air Quality)
E
- Air Quality Complaint Form
- Emergency Project Attachment (Asbestos)
- Emission Inventory Submittal (Air Quality)
- Environmental Response and Remediation Forms
- EPA MBE/ WBE Form
F
- Form 17.2: Trust agreements.
- Form 17.3: Surety bond guaranteeing payment into a standby trust agreement trust fund.
- Form 17.4: Irrevocable standby letter of credit with standby trust agreement.
- Form 17.5: Insurance endorsement of clean-up and closure.
- Form 17.6: Used oil transporter pollution liability endorsement for sudden occurrence.
- Form 17.7: Used oil pollution liability endorsement for sudden occurrences.
- Form 17.8: Used oil pollution liability endorsement for non-sudden occurrences.
- Form 17.9: Used oil pollution liability endorsement for sudden and non-sudden occurrences.
- Form 17.10: Letter of Credit for third-party damages from environmental pollution liability with optional standby trust agreement to be used by transfer, processor, re-refiner, or off-specification burner facility.
- Form 17.11: Payment bond for third-party damages from environmental pollution liability to be used by transfer, processor, re-refiner, or off-specification burner facility.
- Form 17.12: Trust agreement for for third-party damages from environmental pollution liability to be used by transfer, processor, re-refiner, or off-specification burner facility.
- Form 17.13: Standby trust agreement, if and when applicable to certain financial mechanisms associated with third-party damages from environmental pollution liability requiring a standby trust agreement to be used by transfer, processor, re-refiner, or off-specification burner facility.
- Form 17.14: Standby trust agreement, if and when applicable to certain financial mechanisms requiring a standby trust agreement, other than liability, to be used by transfer, processor, re-refiner, or off-specification burner facility.
- Financial Information: Drinking Water:
- Form 1: Notice of Intent (New Source Review; Air Quality)
- Form 2: Processing Information (Air Quality)
- Form 3: Afterburner (Air Quality)
- Form 4: Flare (Air Quality)
- Form 5: Adsorption Unit (Air Quality)
- Form 6: Cyclone (Air Quality)
- Form 7: Condenser (Air Quality)
- Form 8: Electrostatic Precipitator (Air Quality)
- Form 9: Scrubber / Wet Collector (Air Quality)
- Form 10: Fabric Filter (Bag House) (Air Quality)
- Form 11: Internal Combustion Engine (Air Quality)
- Form 12: Incinerator (Air Quality)
- Form 13: Spray Booth (Air Quality)
- Form 14: Concrete Batch Plant (Air Quality)
- Form 15: Rock Crushing and Screening (Air Quality)
- Form 15a: Notice of Temporary Relocation of Portable Equipment (Air Quality)
- Form 15b: Equipment Registration Form for Generic Portable Equipment (Air Quality)
- Form 15c: General Permit Application for Portable Equipment (Air Quality)
- Form 16: Soil/Groundwater Hydrocarbon Remediation (Air Quality)
- Form 17: Diesel Powered Standby Generator (Air Quality)
- Form 17a: Natural Gas Powered Standby Generator (Air Quality)
- Form 18: Portable Hot Mix Drum Asphalt Plant (Air Quality)
- Form 19: Fuel Burning Equipment (Boilers, Heater, Steam Generators) (Air Quality)
- Form 20: Organic Liquid Storage Tank (Air Quality)
- Form 21: Solvent Metal Cleaning (Degreaser) (Air Quality)
- Form 22: Combustion Turbine (Air Quality)
- Form 23: Rotary Kiln (Air Quality)
- Funding Assistance Forms (Water Quality)
G
- Galvanic (Sacrificial Anode) Cathodic Protection:
- Gas Chlorinator, Monthly Report Form
- GRAMA Request Form
- Ground Water/Consecutive System DBP Quarterly Report
- Ground Water Discharge Permit Application (Water Quality)
H
I
- IDSE Report for Standard Monitoring (Blank)
- Impressed Current Cathodic Protection:
- Incinerator Annual Report Form: Solid and Hazardous Waste:
- Individual Certification Form for All Disciplines (Asbestos):
- Industry Breakdown Report: Stationary Source: Air Quality
- Initial Certified Consultants Application (DERR)
- Initial Groundwater and Soil Sampler Application (DERR)
- Initial UST Installer Application
- Initial UST Remover Application
- Inspection Form: Qualified Experts: X-Ray Program
J
- N/A
K
- N/A
L
- Landfill Annual Report Form: Solid and Hazardous Waste:
- Landfill Design Capacity Form (Air Quality):
- Landfill NMOC Emissions Rate Report Form (Air Quality):
- Landspreading Facility Annual Report Form: Solid and Hazardous Waste:
- Lead and Copper Certification: Drinking Water
- Lead and Cooper Consumer Notice Certification Form (Drinking Water):
- Lead in Schools Checklist: Drinking Water
- Lead Sampling Summary Sheet: Drinking Water
- Lead-Based Paint Forms
- Less than NESHAP Asbestos Removal Projects
M
- Monthly Electronic Report: Water Treatment Facility
- Municipal Wastewater Planning Program (MWPP) Annual Report
N
- New, Transfer, and Disposed-of X-ray Equipment Form
- New Public Water System Supplemental Form
- Notice of Inspection (Water Quality)
- Notification Form: EPA Form 7530-1
- Notification of Regulated Activities Form (EPA Form 8700-12)
- NPS Funding Application (Water Quality)
- NPS Project Ranking Form (Water Quality)
O
- Off-Specification Burners Annual Report: Solid and Hazardous Waste
- Onsite Professionals Application Forms (Water Quality)
- OP Application Checklist (Air Quality):
- ZIP
- Operating Permit Checklist: Drinking Water
P
- Permit Application for Off-specification Used Oil Fuel Burners
- Permit Application for Used Oil Processors and Re-refiners
- Permit Application for Used OIl Transfer Facilities
- Permit Application for Used Oil Transporters
- Permitting Forms (Air Quality)
- Post-Closure Care Annual Report Form: Solid and Hazardous Waste:
- Post-Training Course Notification: Lead-Based Paint
- Post-Training Notification Form (Asbestos)
- Pre-award Compliance Review Report: Drinking Water
- Preliminary Evaluation Report Format: Drinking Water
- Previous Pollution Incidents Form (DERR):
- Processors Annual Report: Used Oil
- Project Notification Form: Drinking Water:
- PST Loan Fund Application
- Public Notification Templates: Drinking Water
Q
R
- Re-certification Applications for Individuals: Lead-Based Paint
- Recertification Form: Mammography Physicists
- Recertification Form: Qualified Experts: X-Ray Program
- Recycling Facility Annual Report Form: Solid and Hazardous Waste:
- Registration for Used Oil Fuel Marketer
- Registration Form: Attest.pdfs: X-Ray Program
- Registration: Small Source Exemption Registration Form
- Renewal Certified Consultants Application (DERR)
- Renewal Grdwater andoun Soil Sampler Application (DERR)
- Renewal UST Installer Application
- Renewal UST Removal Application
- Renovation and Demolition Projects with NESHAP Asbestos Removal
- Request for Payment Voucher (DERR)
- Revision Form (Asbestos)
S
- Sales Tax Exemption Application Form (Air Quality):
- Sample Monitoring Report Form (Air Quality):
- Sample Permit Deviation Report (Air Quality):
- Seasonal Start Up: Drinking Water
- Small Business Assistance Form: Solid and Hazardous Waste
- Stationary Source Compliance Complaint Form
- Storm Water Permit Issuance System
- Submit Applications and Payments Online (DERR)
T
- Targeted Brownfields Assessment Application: DERR
- Temporary Closure (UST):
- Tire Storage Facility Annual Report Form: Solid and Hazardous Waste:
- Title V Operating Permit Application Form (Air Quality):
- Training Course Notification: Lead-Based Paint
- Training Notification Form (Asbestos)
- Transfer Annual Report: Used Oil
- Transfer Station Annual Report From: Solid and Hazardous Waste:
- Transporters Annual Report: Used Oil
U
- Update Template: Drinking Water Source Protection
- Use Waiver Statement: Drinking Water Source Protection
- UST Inspector Application
- UST Installation Permit Form
- UST Operator Monthly Inspection Form
- UST Tester Application
- Utah Certified UST Cathodic Protectionh (CP) Tester Application
- Utah Pollutant Discharge Elimination System (UPDES) Permits Forms
- Utah Underground Injection Control (UIC) Program: Forms and Applications
V
- Very Small System Template (Drinking Water):
- Voluntary Cleanup Program Application (CERCLA)
W
- W-9 Request for Taxpayer Identification Number and Certification
- Waste Tire Recycler Registration Application
- Waste Tire Storage Application and Checklist
- Waste Tire Transporter Registration Application
- Wastewater Operator Certification Application
- Water Quality Forms
- Water Quality Corrosion Control Monthly Report
- Waiver Checklist: Drinking Water Source Protection
X
Y
- N/A
Z
- N/A