NC Department of Environment and Natural Resources
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Waste Management
UST FORMS
Corrective Action | Revision Date | PDF | Doc | |
| UST-61 | 24-Hour Release and UST Leak Reporting Form | 2/2008 |  | |
| UST-62 | 24-Hour Notification of Discharge Form | 4/2010 | | |
| Instructions and Form for Notice of Residual Petroleum | 2/1/2010 | |||
| Instructions and Form for Notice of Residual Petroleum with Alternate Land Use Restriction | 2/1/2010 |  | ||
| Soil Permitting | ||||
| UST-59 | Groundwater Quality Monitoring Compliance Report Form | 9/2003 | |  |
| UST-70 | Non-Discharge Permit Application for Soil Remediation Projects | 1/2010 | | |
| UST-71 | Certificate of Approval for Storage/Treatment of Soil Containing Petroleum Products | 5/2011 | | |
| UST-72 | Agreement for Land Application or Containment and Treatment of Soils Containing Petroleum Products on Private Lands | 5/2011 | | |
Permits and Inspections | ||||
| UST-2 | Site Investigation Report for Permanent Closure or Change-In-Service | 12/2011 | |  |
| UST-3 | Notice of Intent: UST Permanent Closure or Change-In-Service | 12/2011 | | |
| UST-4 | Notice of Intent to Install Vapor or Groundwater Monitoring System | 2/2001 | | |
| UST-5 | Site Investigation Report for Installation of Vapor or Groundwater Monitoring System | 2/2001 | | |
| UST-6A/B | Application to Install or Replace USTs (Complete application package) | 3/2012 | | |
| UST-6A/B | Application to Install or Replace USTs (6A/B Only) | 3/2012 | | |
| UST-6C | Application to Install or Replace USTs (Schedule of Materials) | 12/2010 | | |
| UST-6D | Application to Install or Replace USTs (UST Spill Bucket Testing) | 3/2012 | | |
| UST-6E | Application to Install or Replace USTs (Tank Installation Testing) | 3/2012 | | |
| UST-6F | Application to Install or Replace USTs (Containment Sump/UDC Testing) | 3/2012 | | |
| UST-6G | Application to Install or Replace USTs (Piping Integrity Testing) | 3/2012 | | |
| UST-7A | Cathodic Protection Testing form for galvanic cathodic protection systems | 12/2011 | | |
| UST-7B | Cathodic Protection Testing form for impressed current cathodic protection systems | 12/2011 | | |
| UST-8 | Notification for Activities Involving Underground Storage Tanks | 12/2011 | | |
| UST-10A | UST Installation Inspection Checklist | 12/2009 | | |
| UST-10B | UST General Requirements Inspection Checklist | 7/2010 | | |
| UST-12 | Closure Report Format | 8/2008 | | |
| UST-13 | Compartment Tank Notification | 2/2001 | | |
| UST-15 | Change of Ownership of UST System(s) | 11/2011 | |  |
| UST-15A | Ownership of UST Systems | 11/2011 | | |
| UST-16 | Manual Tank Gauging Record | 3/2004 | | |
| UST-17A | UST Suspected Release 24 Hour Notice Form | 12/2011 | | |
| UST-17B | UST Suspected Release 7 Day Notice Form | 2/2012 | | |
| UST-18 | Application for Tax Certification | 12/2011 | | |
| UST-19 | Certification of Leak Detection Exempt for Suction Piping Associated with USTs | 12/2011 | | |
| UST-20 | Alternative Fuel Compatibility Checklist | 3/2012 | | |
| UST-21 | Impressed Current Cathodic Protection System 60-Day Record of Rectifier Operation | 12/2011 | |  |
| UST-22A | Annual Overfill Prevention Operability Check | 12/2011 | | |
| UST-22B | Annual Interstitial Sensor Operability Check | 12/2011 | | |
| UST-22C | Annual Containment Sump Visual Inspections | 12/2011 | | |
| UST-23A | Triennial UST Spill Bucket Integrity Testing | 3/2012 | | |
| UST-23B | Triennial UST Containment Sump/UDC Integrity Testing | 3/2012 | | |
| UST-23C | Triennial UST Piping Integrity Testing | 3/2012 | | |
| UST-23D | Triennial UST Interstice Integrity Testing | 3/2012 | | |
| UST-24 | Certification of No Visible Corrosion on Metallic Piping Components | 12/2011 | | |
| UST-26 | Emergency Response Operator Training Log | 12/2011 | | |
State Cleanup Funds | ||||
| Eligibility Forms | ||||
| Changes effective 3/1/08 Memo | 3/2008 | | ||
| Memo Eligibility Application Form 01/09 | 1/2009 | | ||
| Eligibility Application Form (rev 01/09 ) | 1/2009 | | ||
| Extra Tank Data Worksheet | 2/2008 | | ||
| Extra Corrosion Protection & Spill Overflow worksheet | 2/2008 | | ||
Reasonable Rate Documents | ||||
| 98 & 03 Reasonable Rates | ||||
Financial Responsibility | ||||
| Chief Financial Officer Letter | 11/2005 | | ||
| UST-FR1 | Certificate of Insurance (UST-FR1) | 12/2011 | | |
| Certification of Financial Responsibility | 3/2009 | | ||
Federal Cleanup Funds | ||||
| Financial Data Request Form | 1/2004 | | ||
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UST Section • 217 West Jones Street, Raleigh, North Carolina 27603 • (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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