Underground Storage Tank Regulatory Compliance Forms

Regulatory Compliance Checklists:

Inspection Checklist prior to April 2008  (PDF, 260.67 KB)

Inspection Checklist after April 2008  (PDF, 241.12 KB)

Inspection Checklist for EG prior to April 2008  (PDF, 264.47 KB)

Inspection Checklist for EG after April 2008  (PDF, 251.76 KB)

Changing In Use/Temporarily Out of Use Status:

Checklist for Temporarily Out of Use to In Use  (PDF, 161.5 KB)

Checklist for In Use to Temporarily Out of Use  (PDF, 184.46 KB)  Tanks can only remain in TOU status for 12-consecutive months if the facility is out of compliance.

Operator Notifications:

Notification of Class A, B, and C Operators  (PDF, 295.76 KB)  

New Installation and New Data Notification:

• New UST Installation Package
• Form 7530 – Notification Data for UST   (PDF, 693.09 KB)

Financial Responsibility Guidance and Forms:

Financial Responsibility Guidance  (PDF, 1.02 MB)

Certificate of Financial Responsibility  (PDF, 650.15 KB)    (PDF, 650.15 KB)

GUST Trust Fund Confirmation  (PDF, 230.33 KB)

• Financial Responsibility Forms for All Owners/Operators
  • Financial Test (Self-Insurance)  (PDF, 169.95 KB)  - Form A- Must be completed by Chief Financial Officer.
  • Guarantee  (PDF, 218.52 KB)  - Form B
  • Insurance Endorsement  (PDF, 132.51 KB)  - Form C
  • Certificate of Insurance  (PDF, 132.83 KB)  - Form D
  • Performance Bond  (PDF, 170.15 KB)  - Form E
  • Letter of Credit  (PDF, 180.96 KB)  - Form F- Must be completed by the Financial Institution
  • Trust Fund  (PDF, 309.36 KB)  - Form G
  • Standby Trust Fund  (PDF, 246.24 KB)  - Form H
• Financial Responsibility for Local Governments
  • Bond  (PDF, 264.11 KB)  - Form I
  • Financial Test  (PDF, 244.95 KB)  - Form J
  • Fund  (PDF, 282.2 KB)  - Form K
  • Guarantee 1  (PDF, 732.33 KB)  - Form L
  • Guarantee 2  (PDF, 276.86 KB)  - Form M
  • Guarantee 3  (PDF, 262.57 KB)  - Form N
  • Guarantee 4  (PDF, 279.45 KB)  - Form O

Facility Equipment Testing Forms:

Containment Sump Testing

Containment Sump Test Form  (PDF, 364.74 KB)  

Containment Sump Low Level Test Form  (PDF, 173.79 KB)  

Guidance for Low Level Hydrostatic Test  (PDF, 503.24 KB)  

Overfill Prevention

Alarm and Diagram  (PDF, 808.04 KB)  

Ball Float Inspection and Diagram  (PDF, 1.31 MB)  

Flapper Valve and Diagram  (PDF, 1.4 MB)  

Appendix C Complete Shutoff  (PDF, 562.63 KB)

Spill Prevention (Spill Bucket)

Three-year Spill Prevention Equipment (Spill Bucket) Integrity Test Report  (PDF, 251 KB)  

Release Detection Equipment Testing

Probe Test  (PDF, 1.1 MB)  

Leak Detector Test  (PDF, 257.52 KB)

Sensor Functionality Test   (PDF, 197.37 KB)

Cathodic Protection Testing

Galvanic-Cathodic Protection Monitoring Form  (PDF, 1.07 MB)  

Impressed Current-Cathodic Protection Monitoring Form  (PDF, 943.41 KB)  

Walkthrough Inspection

30-day Walkthrough Inspection Checklist  (PDF, 878.45 KB)  

Annual Walkthrough Inspection Checklist  (PDF, 864.53 KB)

Monthly Visual Inspection

Visual Interstitial Monitoring Monthly Log  (PDF, 232.13 KB)

Compatibility 

Compatibility Demonstration Log  (PDF, 457.16 KB)  

Stage I EVR Test (only in ozone non-attainment areas):

Stage I EVR Test Notification Form  (PDF, 732.15 KB)  - Note that this is a fillable PDF form and you will need to download it to your computer before completing it.

Other Forms