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 (175 KB)
- Alternative Work Practice Form (Asbestos) (856 KB)
- Asbestos Renovation/Abatement Notification Form (293 KB)
- Application for Course Accreditation: Lead-Based Paint
- Application for Used Oil Collection Center (427 KB)
- Application Form: Financial Assistance: Drinking Water (487 KB)
- Application Form: Mammography Physicists (132 KB)
- Arsenic Exemption Worksheet (16 KB)
- Asbestos Alternative Work Practice Request Form (856 KB)
- Asbestos Company Certification Application (356 KB)
- Asbestos Emergency Renovation/Abatement or Ordered Notification Form (770 KB)
- Asbestos Individual Certification Application Form (349 KB)
- Asbestos Renovation/Abatement Forms (286 KB)
- Asbestos of Lead-Based Paint Requirements for Certifications (106 KB)
- Asbestos Pre-Ratenovion Form (67 KB)
- Assessment Grant Funding (15KB)
- Attachment C:List of Hazardous Air Pollutants (Small Source Exemption; Air Quality) (35 KB)
- Attachment D: Wood Finisher Worksheet (Small Source Exemption; Air Quality) (21 KB)
- Attachment E: Printer Worksheet (Small Source Exemption; Air Quality) (26 KB)
- Attachment F: Auto Body Refinisher Worksheet (Small Source Exemption; Air Quality) (17 KB)
B
- N/A
C
- Capacity Assessment Worksheets (399 KB)
- Certificate of Compliance Application Form (DERR):
- Certification Application for Firms: Lead-Based Paint (130 KB)
- Certification Application for Individuals: Lead-Based Paint (152 KB)
- Certificate of Compliance Packet (DERR) (110 KB)
- Certification Form for All Companies (Asbestos)
- Certification Program Forms (DERR)
- Citizenship Certification: Senate Bill 81 (25 KB)
- Citizenship Certification: Water Quality (839 KB)
- Citizenship Certification Form (Asbestos and Lead-based Paint) (356 KB)
- Class I Non-Hazardous Injection Well Permit Application Package (101 KB)
- Class III Permit Application Package for Solution Mining of Salts or Potash (102 KB)
- Class V Authorized-By-Rule Change of Operating Status Form (51 KB)
- Class V General Permit Application Package (52 KB)
- Class V Permit Application Package for Aquifer Storage and Recovery (110 KB)
- 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) (122 KB)
- Form 2: Processing Information (Air Quality) (94 KB)
- Form 3: Afterburner (Air Quality) (103 KB)
- Form 4: Flare (Air Quality) (45 KB)
- Form 5: Adsorption Unit (Air Quality) (83 KB)
- Form 6: Cyclone (Air Quality) (101 KB)
- Form 7: Condenser (Air Quality) (35 KB)
- Form 8: Electrostatic Precipitator (Air Quality) (91 KB)
- Form 9: Scrubber / Wet Collector (Air Quality) (89 KB)
- Form 10: Fabric Filter (Bag House) (Air Quality) (88 KB)
- Form 11: Internal Combustion Engine (Air Quality) (134 KB)
- Form 12: Incinerator (Air Quality) (111 KB)
- Form 13: Spray Booth (Air Quality) (79 KB)
- Form 14: Concrete Batch Plant (Air Quality) (95 KB)
- Form 15: Rock Crushing and Screening (Air Quality) (29 KB)
- Form 15a: Notice of Temporary Relocation of Portable Equipment (Air Quality) (29 KB)
- Form 15b: Equipment Registration Form for Generic Portable Equipment (Air Quality) (42 KB)
- Form 15c: General Permit Application for Portable Equipment (Air Quality) (42 KB)
- Form 16: Soil/Groundwater Hydrocarbon Remediation (Air Quality) (111 KB)
- Form 17: Diesel Powered Standby Generator (Air Quality) (30 KB)
- Form 17a: Natural Gas Powered Standby Generator (Air Quality) (30 KB)
- Form 18: Portable Hot Mix Drum Asphalt Plant (Air Quality) (70 KB)
- Form 19: Fuel Burning Equipment (Boilers, Heater, Steam Generators) (Air Quality) (91 KB)
- Form 20: Organic Liquid Storage Tank (Air Quality) (79 KB)
- Form 21: Solvent Metal Cleaning (Degreaser) (Air Quality) (87 KB)
- Form 22: Combustion Turbine (Air Quality) (88 KB)
- Form 23: Rotary Kiln (Air Quality) (100 KB)
- Funding Assistance Forms (Water Quality)
G
- Galvanic (Sacrificial Anode) Cathodic Protection:
- Gas Chlorinator, Monthly Report Form (70 KB)
- GRAMA Request Form (71 KB)
- Ground Water/Consecutive System DBP Quarterly Report (50 KB)
- Ground Water Discharge Permit Application (Water Quality)
H
I
- IDSE Report for Standard Monitoring (Blank) (283 KB)
- Impressed Current Cathodic Protection:
- Incinerator Annual Report Form: Solid and Hazardous Waste:
- Individual Certification Form for All Disciplines (Asbestos):
- Asbestos Individual (349 KB)
- Lead Based Paint Individual (254 KB)
- Industry Breakdown Report: Stationary Source: Air Quality
- Initial Certified Consultants Application (DERR) (720 KB)
- Initial Groundwater and Soil Sampler Application (DERR) (485 KB)
- Initial UST Installer Application (720 KB)
- Initial UST Remover Application (773 KB)
- Inspection Form: Qualified Experts: X-Ray Program (140 KB)
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 (4 MB)
- Lead Sampling Summary Sheet: Drinking Water
- Lead-Based Paint Forms
- Less than NESHAP Asbestos Removal Projects (286 KB)
M
- Monthly Electronic Report: Water Treatment Facility (246 KB)
- Municipal Wastewater Planning Program (MWPP) Annual Report
N
- New, Transfer, and Disposed-of X-ray Equipment Form (66 KB)
- New Public Water System Supplemental Form (316 KB)
- Notice of Inspection (Water Quality) (54 KB)
- Notification Form: EPA Form 7530-1 (276 KB)
- Notification of Regulated Activities Form (EPA Form 8700-12)
- NPS Funding Application (Water Quality) (104 KB)
- NPS Project Ranking Form (Water Quality) (90 KB)
O
- Off-Specification Burners Annual Report: Solid and Hazardous Waste (276 KB)
- Onsite Professionals Application Forms (Water Quality)
- OP Application Checklist (Air Quality):
- ZIP (49 KB)
- Operating Permit Checklist: Drinking Water (96 KB)
P
- Permit Application for Off-specification Used Oil Fuel Burners (379 KB)
- Permit Application for Used Oil Processors and Re-refiners (447 KB)
- Permit Application for Used OIl Transfer Facilities (346 KB)
- Permit Application for Used Oil Transporters (259 KB)
- Permitting Forms (Air Quality)
- Post-Closure Care Annual Report Form: Solid and Hazardous Waste:
- Post-Training Course Notification: Lead-Based Paint (36 KB)
- Post-Training Notification Form (Asbestos) (137 KB)
- Pre-award Compliance Review Report: Drinking Water (249 KB)
- Preliminary Evaluation Report Format: Drinking Water (43 KB)
- Previous Pollution Incidents Form (DERR):
- Processors Annual Report: Used Oil (429 KB)
- Project Notification Form: Drinking Water:
- Excel 2003 (26 KB)
- Excel 2010 (27 KB)
- PDF (335 KB)
- PST Loan Fund Application:
- Public Notification Templates: Drinking Water
Q
R
- Re-certification Applications for Individuals: Lead-Based Paint (132 KB)
- Recertification Form: Mammography Physicists (142 KB)
- Recertification Form: Qualified Experts: X-Ray Program (142 KB)
- Recycling Facility Annual Report Form: Solid and Hazardous Waste:
- Registration for Used Oil Fuel Marketer (329 KB)
- Registration Form: Attest.pdfs: X-Ray Program (142 KB)
- Registration: Small Source Exemption Registration Form (57 KB)
- Renewal Certified Consultants Application (DERR) (141 KB)
- Renewal Grdwater andoun Soil Sampler Application (DERR) (485 KB)
- Renewal UST Installer Application
- Renewal UST Removal Application (773 KB)
- Renovation and Demolition Projects with NESHAP Asbestos Removal (286 KB)
- Request for Payment Voucher (DERR) (28 KB)
- Request for Public Information (71 KB)
- Revision Form (Asbestos) (286 KB)
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)
- Susceptibility Waiver Statement: Drinking Water
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) (123 KB)
- Transfer Annual Report: Used Oil (346 KB)
- Transfer Station Annual Report From: Solid and Hazardous Waste:
- Transporters Annual Report: Used Oil (259 KB)
U
- Update Template: Drinking Water Source Protection (59 KB)
- Use Waiver Statement: Drinking Water Source Protection (21 KB)
- UST Inspector Application (11 KB)
- UST Installation Permit Form (97 KB)
- UST Operator Monthly Inspection Form (90 KB)
- UST Tester Application (725 KB)
- Utah Certified UST Cathodic Protectionh (CP) Tester Application (34 KB)
- 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) (32 KB)
W
- W-9 Request for Taxpayer Identification Number and Certification (1 MB)
- Waste Tire Recycler Registration Application (314 KB)
- Waste Tire Storage Application and Checklist (115 KB)
- Waste Tire Transporter Registration Application (627 KB)
- Wastewater Operator Certification Application (74 KB)
- Water Quality Forms
- Water Quality Corrosion Control Monthly Report (105 KB)
- Waiver Checklist: Drinking Water Source Protection (28 KB)
X
- X-Ray Assembler Notification Form (14 KB)
- X-Ray Machine Registration Form (169 KB)
- X-Ray Program Forms
Y
- N/A
Z
- N/A