North Carolina Department of Environment and Natural Resources
  
                UST FORMS


Corrective Action  

Revision Date
PDF
Doc

20 Day Report 8/2008

20 Day Report

UST Clean Closure 8/2008

UST Clean Closure

GCL Table
1/2010
GCL Table 02/06

Initial Abatement 7/2001

UST2 Word

MSCC Table
1/2010 MSCC Table 02/06

Site Check Report 8/2008

Site Check Report
UST-61 24-Hour Release and UST Leak Reporting Form
2/2008
24-Hour Release and UST Leak Reporting Form






 Soil Permitting


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
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-72 Agreement for Land Application or Containment and Treatment of Soils Containing Petroleum Products on Private Lands
9/2003
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 Inspections




UST-2 Site Investigation Report for Permanent Closure or Change-In-Service 11/2006 Site Investigation Report for Permanent Closure or Change-In-Service
UST-3 Notice of Intent: UST Permanent Closure or Change-In-Service 10/2006 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 Investgation Report for Installation of Vapor or Groundwater Montoring System 2/2001 Site Investgation Report for Installation of Vapor or Groundwater Montoring System
UST-6A/B Notice of Intent to Install USTs
12/2008 Notice of Intent to Install USTs Cathodic Protection Testing form for galvanic cathodic protection systems
UST-7A Cathodic Protection Testing form for galvanic cathodic protection systems
9/2008
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 impresses current cathodic protection systems 9/2008 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 2/2008
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
9/2009
UST General Requirements Inspection Checklist
UST-12 Closure Report Format 11/2000
Closure Report Format
UST-13 Compartment Tank Notfication 2/2001
Compartment Tank Notfication
UST-15 Change of Ownership of UST System(s) 11/2000
Change of Ownership of UST System(s)
UST-15A Ownership of UST Systems
2/2002
Ownership of UST Systems
UST-16 Manual Tank Gauging Record 3/2004
Manual Tank Gauging Record
UST-17A UST Suspected Release 24 Hour Notice Form 11/2006
ST Suspected Release 24 Hour Notice Form ST Suspected Release 24 Hour Notice Form
UST-17B UST Suspected Release 7 Day Notice Form 10/2006
UST Suspected Release 7 Day Notice Form UST Suspected Release 7 Day Notice Form
UST-18 Application for Tax Certification 5/2004
Application for Tax Certification Application for Tax Certification
UST-19 Certification of Leak Detection Exempt for Suction Piping Associated with USTs 8/2005
Application for Tax Certification Certification of Leak Detection Exempt for Suction Piping Associated with USTs
UST-20 Alternative Fuel Compatability Checklist 3/2007
Alternative Fuel Compatability Checklist Alternative Fuel Compatability Checklist
UST-21 Impressesd Current Cathodic Protection System 60-Day Record of Rectifier Operation 9/2008
mpressesd Current Cathodic Protection System 60-Day Record of Rectifier Operation
UST-22A
Annual Overfill Prevention Equipment Operability Check
3/2010
Annual UST Equipment Operability Check and Sump Visual Inspections Alternative Fuel Compatability Checklist
UST-22B
Annual Interstitial Sensor Operability Check
3/2010
Annual UST Equipment Operability Check and Sump Visual Inspections Alternative Fuel Compatability Checklist
UST-22C
Annual Containment Sump Visual Inspections
3/2010
Annual UST Equipment Operability Check and Sump Visual Inspections Alternative Fuel Compatability Checklist
UST-23A Triennial UST Spill Bucket Integrity Testing
3/2010 Triennial UST Spill Bucket Integrity Testing Alternative Fuel Compatability Checklist
UST-23B Triennial UST Containment Sump/UDC Integrity Testing 3/2010 Triennial UST Containment Sump/UDC Intergrity Testing Alternative Fuel Compatability Checklist
UST-23C Triennial UST Piping Integrity Testing 3/2010 Triennial UST Piping Intergrity Testing Alternative Fuel Compatability Checklist
UST-23D
Triennial UST Interstice Integrity Testing 3/2010
Alternative Fuel Compatability Checklist Alternative Fuel Compatability Checklist






State Trust Funds





Eligibility Forms



Changes effective 3/1/08  Memo 3/2008

Changes effective 3/1/08  Memo

Memo Eligibility Application Form 1/2009

Memo Eligibility Application Form 01/09

Eligibility Application Form
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








Financial Responsibility





Chief Financial Officer Letter 11/2005
Chief Financial Officer Letter

Certificate of Insurance (UST-FR1)  
5/2006
Certificate of Insurance (UST-FR1) Certificate of Insurance (UST-FR1)

Certification of Financial Responsibility 3/2009
Certification of Financial Responsibility






Federal Trust Funds





Financial Data Request Form 1/2004
Financial Data Request Form









North Carolina Division of Waste Management
1646 Mail Service Center, Raleigh, NC 27699-1646
(919)508-8400