State Forms and Templates

State Forms

The following state forms are available on the IDEM Forms page. Instructions are provided at the top of each form. In some cases, additional instructions are posted on the IDEM Forms page.

  • Underground Storage Tank (UST) Program:
    • Notification for Underground Storage Tanks - 45223
    • Notice of Intent to Purchase UST and Reinstate ELTF Eligibility - 48079
    • Request for Certificate of Financial Assurance for Underground Storage Tanks - 52884
  • Leaking Underground Storage Tank Program:
    • Leaking Underground Storage Tank (UST) Initial Incident Report - 54487
    • Initial Site Characterization (ISC) Checklist - 55440
    • Initial Site Characterization (ISC) Report Cover Sheet & Report Format - 55439
    • Further Site Investigation (FSI) Report Cover Sheet & Report Format - 55441
    • Leaking Underground Storage Tank Quarterly Monitoring Report (QMR) Cover Sheet and Report Format - 56087
    • No Further Action Request Cover Sheet and Report Format - 56088
  • Excess Liability Trust Fund:
    • Excess Liability Trust Fund Eligibility Application - 55459
    • Excess Liability Trust Fund Application - 47139
    • Excess Liability Trust Fund Confirmation of Emergency Response Status - 55458
    • Scope of Work - 51955
    • Site Categorization for Prioritization of Claims - 51920

Templates

Property owners use an environmental restrictive covenant to document remaining contamination at a leaking underground storage tank site and to restrict property activity, use, and access to limit the potential for human exposure to contaminants. More information is available on IDEM Environmental Cleanups: Institutional Controls page.