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N.C. Department of Environment and Natural Resources

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 1/15/2013  

  Instructions and Form for Notice of Residual Petroleum with Alternate Land Use Restriction 1/15/2013    
         
   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 InspectionRevision DatePDFDOC
UST-2Site Investigation Report for Permanent Closure or Change-In-Service12/2011Site Investigation Report for Permanent Closure or Change-In-Service 
UST-3Notice of Intent: UST Permanent Closure or Change-In-Service12/2011Notice of Intent: UST Permanent Closure or Change-In-Service 
UST-4Notice of Intent to Install Vapor or Groundwater Monitoring System2/2001Notice of Intent to Install Vapor or Groundwater Monitoring System 
UST-5Site Investigation Report for Installation of Vapor or Groundwater Monitoring System2/2001Site Investgation Report for Installation of Vapor or Groundwater Montoring System 
UST-6See Table below for UST-6 Installation Forms   
UST-7ACathodic Protection Testing form for galvanic cathodic protection systems
12/2011
Cathodic Protection Testing form for galvanic cathodic protection systemsCathodic Protection Testing form for galvanic cathodic protection systems
UST-7BCathodic Protection Testing form for impressed current cathodic protection systems12/2011Cathodic Protection Testing form for impresses current cathodic protection systemsCathodic Protection Testing form for impresses current cathodic protection systems
UST-8Notification for Activities Involving Underground Storage Tanks12/2011
Notification for Activities Involving Underground Storage TanksNotification for Activities Involving Underground Storage Tanks
UST-10AUST Installation Inspection Checklist12/2009UST Installation Inspection Checklist 
UST-10BUST General Requirements Inspection Checklist
7/2010
UST General Requirements Inspection Checklist 
UST-12Closure Report Format8/2008
 Closure Report Format
UST-13Compartment Tank Notification2/2001
Compartment Tank Notfication 
UST-15Change of Ownership of UST System(s)11/2011
Change of Ownership of UST System(s) 
UST-15AOwnership of UST Systems
11/2011
Ownership of UST Systems 
UST-16Manual Tank Gauging Record3/2004
Manual Tank Gauging Record 
UST-17AUST Suspected Release 24 Hour Notice Form12/2011
ST Suspected Release 24 Hour Notice FormST Suspected Release 24 Hour Notice Form
UST-17BUST Suspected Release 7 Day Notice Form2/2012
UST Suspected Release 7 Day Notice FormUST Suspected Release 7 Day Notice Form
UST-18Application for Tax Certification12/2011
Application for Tax CertificationApplication for Tax Certification
UST-19Certification of Leak Detection Exemption for Suction Piping Associated with USTs12/2011
Application for Tax CertificationCertification of Leak Detection Exempt for Suction Piping Associated with USTs
UST-20Alternative Fuel/Hazardous Substance Compatibility Checklist3/2012
Alternative Fuel Compatability ChecklistAlternative Fuel Compatability Checklist
UST-21Impressed Current Cathodic Protection System 60-Day Record of Rectifier Operation12/2011
mpressesd Current Cathodic Protection System 60-Day Record of Rectifier Operation 
UST-22AAnnual Overfill Prevention Operability Check5/2013Annual Overfill Prevention Operability CheckAnnual Overfill Prevention Operability Check
UST-22BAnnual Interstitial Sensor Operability Check12/2011Annual Interstitial Sensor Operability CheckAnnual Interstitial Sensor Operability Check
UST-22CAnnual Containment Sump Visual Inspections4/2013Annual Containment Sump Visual InspectionsAnnual Containment Sump Visual Inspections
UST-23ATriennial UST Spill Bucket Integrity Testing
5/2013Triennial UST Spill Bucket Integrity TestingTriennial UST Spill Bucket Integrity Testing
UST-23BTriennial UST Containment Sump/UDC Integrity Testing9/2013Triennial UST Containment Sump/UDC Intergrity TestingTriennial UST Containment Sump/UDC Integrity Testing
UST-23CTriennial UST Piping Integrity Testing5/2013Triennial UST Piping Intergrity TestingTriennial UST Piping Integrity Testing
UST-23DTriennial UST Interstice Integrity Testing3/2012Triennial UST Intertice Integrity TestingTriennial UST Intertice Integrity Testing
UST-24Certification of No Visible Corrosion on Metallic Piping Components12/2011Certification of No Visible Corrosion on Mettallic Piping ComponentsCertification of No Visible Corrosion on Mettallic Piping Components
UST-26Emergency Response Operator Training Log12/2011Emergency Response Operator Training Log 
  Permits and Inspection - Installation Forms Revision Date PDF DOC
  Instructions for completing UST-6 Application to Install or Replace USTs
8/2013 Notice of Intent to Install USTs  
UST-6 Application to Install or Replace USTs (Pre/Post-Install)
Effective 8/26/2013 and replaces UST-6A/6B package
8/2013 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6B Application to Install or Replace USTs (6A/B Only)
The UST-6B form will be accepted for installations with previously approved UST-6A (Revised 3/12) applications.
3/2012 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6C Application to Install or Replace USTs (Schedule of Materials)
12/2010 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6D Application to Install or Replace USTs (UST Spill Bucket Testing) 5/2013 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6E Application to Install or Replace USTs (Tank Installation Testing)
3/2012 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6F Application to Install or Replace USTs (Containment Sump/UDC Testing) 9/2013 Notice of Intent to Install USTs Notice of Intent to Install USTs
UST-6G Application to Install or Replace USTs (Piping Integrity Testing) 5/2013 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)  
12/2011
Certificate of Insurance (UST-FR1) Certificate of Insurance (UST-FR1)
  Certification of Financial Responsibility 3/2009
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 • 1637 Mail Service Center, Raleigh, North Carolina 27699-1637 • (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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