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North Carolina Department of Environment Quality

NC Department of Environment and Natural Resources
Waste Management - Forms

Waste Management

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 UST Forms

  Corrective Action Revision Date PDF DOC
UST-61 24-Hour Release and UST Leak Reporting Form
 2/2008
 24-Hour Release and UST Leak Reporting Form  
UST-62 24-Hour Notification of Discharge Form 4/2010 24-Hour Release and UST Leak Reporting Form  
  Instructions and Form for Notice of Residual Petroleum 1/21/2015  

  Instructions and Form for Notice of Residual Petroleum with Alternate Land Use Restriction 1/21/2015    
         
   Soil Permitting
   
UST-59 Groundwater Quality Monitoring Compliance Report Form
 9/2003
 Certificate of Approval for Storage/Treatment of Soil Containing Petroleum Products Certificate of Approval for Storage/Treatment of Soil Containing Petroleum Products
UST-70
 Non-Discharge Permit Application for Soil Remediation Projects
 1/2010
 Non-Discharge Permit Application for Soil Remediation Projects Non-Discharge Permit Application for Soil Remediation Projects
UST-71 Certificate of Approval for Storage/Treatment of Soil Containing Petroleum Products
 5/2011
 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
 5/2011
 Agreement for Land Application or Containment and Treatment of Soils Containing Petroleum Products on Private Lands Agreement for Land Application or Containment and Treatment of Soils Containing Petroleum Products on Private Lands
  Permits and Inspection Revision Date PDF DOC
UST-2A Site Investigation Report for Permanent Closure or Change-In-Service - REGISTERED TANKS 1/2016 Site Investigation Report for Permanent Closure or Change-In-Service  
UST-2B Site Investigation Report for Permanent Closure or Change-In-Service - UNREGISTERED TANKS 1/2016 Site Investigation Report for Permanent Closure or Change-In-Service
UST-3 Notice of Intent: UST Permanent Closure or Change-In-Service 10/2015 Notice of Intent: UST Permanent Closure or Change-In-Service  
UST-4 Notice of Intent to Install Vapor or Groundwater Monitoring System 2/2001 Notice of Intent to Install Vapor or Groundwater Monitoring System  
UST-5 Site Investigation Report for Installation of Vapor or Groundwater Monitoring System 2/2001 Site Investgation Report for Installation of Vapor or Groundwater Montoring System  
UST-6 See Table below for UST-6 Installation Forms      
UST-7A Cathodic Protection Testing form for galvanic cathodic protection systems
10/2015
 Cathodic Protection Testing form for galvanic cathodic protection systems Cathodic Protection Testing form for galvanic cathodic protection systems
UST-7B Cathodic Protection Testing form for impressed current cathodic protection systems 10/2015 Cathodic Protection Testing form for impresses current cathodic protection systems Cathodic Protection Testing form for impresses current cathodic protection systems
UST-8 Notification for Activities Involving Underground Storage Tanks 10/2015
 Notification for Activities Involving Underground Storage Tanks Notification for Activities Involving Underground Storage Tanks
UST-10A UST Installation Inspection Checklist 12/2009 UST Installation Inspection Checklist  
UST-10B UST General Requirements Inspection Checklist
7/2010
 UST General Requirements Inspection Checklist  
UST-12 Closure Report Format 8/2008
   Closure Report Format
UST-13 Compartment Tank Notification 2/2001
 Compartment Tank Notfication  
UST-15 Change of Ownership of UST System(s) 10/2015
 Change of Ownership of UST System(s)  
UST-15A Ownership of UST Systems
10/2015
 Ownership of UST Systems  
UST-16 Manual Tank Gauging Record 10/2015
 Manual Tank Gauging Record  
UST-17A UST Suspected Release 24 Hour Notice Form 10/2015
 ST Suspected Release 24 Hour Notice Form ST Suspected Release 24 Hour Notice Form
UST-17B UST Suspected Release 7 Day Notice Form 10/2015
 UST Suspected Release 7 Day Notice Form UST Suspected Release 7 Day Notice Form
UST-18 Application for Tax Certification 10/2015
 Application for Tax Certification Application for Tax Certification
UST-19 Certification of Leak Detection Exemption for Suction Piping Associated with USTs 10/2015
 Application for Tax Certification Certification of Leak Detection Exempt for Suction Piping Associated with USTs
UST-20 Alternative Fuel/Hazardous Substance Compatibility Checklist 10/2015
 Alternative Fuel Compatability Checklist Alternative Fuel Compatability Checklist
UST-21 Impressed Current Cathodic Protection System 60-Day Record of Rectifier Operation 10/2015
 mpressesd Current Cathodic Protection System 60-Day Record of Rectifier Operation  
UST-22A Annual Overfill Prevention Operability Check 10/2015 Annual Overfill Prevention Operability Check Annual Overfill Prevention Operability Check
UST-22B Annual Leak Detection Equipment Operability Check 10/2015 Annual Interstitial Sensor Operability Check Annual Interstitial Sensor Operability Check
UST-22C Annual Containment Sump Visual Inspections 10/2015 Annual Containment Sump Visual Inspections Annual Containment Sump Visual Inspections
UST-23A Triennial UST Spill Bucket Integrity Testing
10/2015 Triennial UST Spill Bucket Integrity Testing Triennial UST Spill Bucket Integrity Testing
UST-23B Triennial UST Containment Sump/UDC Integrity Testing 10/2015 Triennial UST Containment Sump/UDC Intergrity Testing Triennial UST Containment Sump/UDC Integrity Testing
UST-23C Triennial UST Piping Integrity Testing 10/2015 Triennial UST Piping Intergrity Testing Triennial UST Piping Integrity Testing
UST-23D Triennial UST Interstice Integrity Testing 10/2015 Triennial UST Intertice Integrity Testing Triennial UST Intertice Integrity Testing
UST-24 Certification of No Visible Corrosion on Metallic Piping Components 10/2015 Certification of No Visible Corrosion on Mettallic Piping Components Certification of No Visible Corrosion on Mettallic Piping Components
  Permits and Inspection - Installation Forms Revision Date PDF DOC
  Instructions for completing UST-6 Application to Install or Replace USTs
 10/2015 Notice of Intent to Install USTs  
UST-6 Application to Install or Replace USTs (Pre/Post-Install) 10/2015 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6C Application to Install or Replace USTs (Schedule of Materials)
 10/2015 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6D Application to Install or Replace USTs (UST Spill Bucket Testing) 10/2015 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6E Application to Install or Replace USTs (Tank Installation Testing)
 10/2015 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6F Application to Install or Replace USTs (Containment Sump/UDC Testing) 10/2015 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6G Application to Install or Replace USTs (Pre-Installation Piping Integrity Testing) 10/2015 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6H Application to Install or Replace USTs (Post-Installation Piping Integrity Testing) 10/2015 Notice of Intent to Install USTs Notice of Intent to Install USTs
  Financial Responsibility Revision Date PDF DOC
  Chief Financial Officer Letter 11/2005
 Chief Financial Officer Letter  
 UST-FR1 Certificate of Insurance (UST-FR1)  
10/2015
 Certificate of Insurance (UST-FR1) Certificate of Insurance (UST-FR1)
  Certification of Financial Responsibility 10/2015
 Certification of Financial Responsibility  
  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
   Changes effective 3/1/08 Memo
  Memo Eligibility Application Form 01/09 1/2009
   Memo Eligibility Application Form 01/09
  Eligibility Application Form (rev 01/09 ) 1/2009
   Eligibility Application Form (rev 01/09 )
  Extra Tank Data Worksheet 2/2008
   Extra Tank Data Worksheet
  Extra Corrosion Protection & Spill Overflow worksheet 2/2008
   Extra Corrosion Protection & Spill Overflow worksheet
 
     
 

Reasonable Rate Documents

      
  98 & 03 Reasonable Rates      
         
 

Federal Cleanup Funds
   
  Financial Data Request Form 1/2004
 Financial Data Request Form  

 

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UST Section • 1646 Mail Service Center, Raleigh, North Carolina 27699-1646 • (919) 707-8171 • FAX (919) 715-1117
N.C. Division of Waste Management • 217 West Jones Street, Raleigh, North Carolina 27603 • (919) 707-8200 • FAX (919) 707-8200
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