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ADEM Departmental Forms

Division: Air
Form # Form Name
373 Excess Emission Monitoring Report
494 Birmingham Fuel Supplier Report
052 Registration Form for the Construction, Installation, or Modification of an Incinerator
374 Exemption Claim Form for Cofired Combustors (Appendix H - Division 3)
440 Petroleum Solvent Dry Cleaning Questionnaire
496 Notice of Demolition and/or Asbestos Removal
197 Air Permit Application for Gasoline Dispensing Facilities
375 Exemption Claim Form For Incinerators Burning Only Pathological, Low-Level Radioactive, and Chemotherapeutic Waste (Appendix H - Division 3)
497 Asbestos Removal Contractor Certification
103 Operating Permit Application Facility Identification Form
198 Gasoline Transport Tank Truck Application
378 Gasoline Dispensing Facility Information Survey
519 CAIR Permit Application
017 Specifications for Air Curtain Incinerators
104 Permit Application for Indirect Heating Equipment
105 Permit Application for Manufacturing or Processing Operation
331 Bulk (Gasoline) Plant Application
106 Permit Application for Waste Disposal
107 Permit Application for Stationary Internal Combustion Engines
448 Remediation Approval Form
502 Visible Emission Field Test Sheet
108 Permit Application for Loading and Storage of Organic Compounds
449 Remediation Reporting Form
109 Permit Application for Volatile Organic Compound Surface Coating Emission Source
110 Permit Application for Air Pollution Control Device
309 Cargo Tank Tightness Test Report
039 MEME Vendor Application
112 Permit Application for Solvent Metal Cleaning
434 Open Burning Incident Report
184 Seal Gap Test Form
436 Perc Dry Cleaner Status Update
437 Permit Application for Compliance Schedule
372 Emissions Statement Reporting Form (For Shelby County Facilities Only)
438 Permit Application for Continuous Emission Monitoring Systems (CEMS)
493 112 (j) Part 1 Applicability Notification
Division: Coastal
Form # Form Name
166 Joint Application and Notification U.S. Department of Army, Corps of Engineers Alabama Department of Environmental Management
316 Alabama Coastal Area Management Program Application for Approval of a Non-Regulated Use ADEM Adminstrative Code Rule 335-8-1-.11 Groundwater Extraction 50 GPM or Greater
327 Application for a Permit for the Construction of a Motel, Hotel, or Other Multi-Unit Development on a Property Intersected by the Construction Control Line in the Alabama Coastal Area
328 Application for a Permit for the Construction of Single Family Dwellings, Duplexes, or Other Similar Structures on Properties Intersected by the Construction Control Line in the Alabama Coastal Area
329 Application for Approval of a Non-Regulated Use in the Alabama Coastal Area Developments and Subdivisions of Property Greater then 5 Acres in Size
Division: Waste/Remediation
Form # Form Name
540 Scrap Tire Processor Permit Application
556 3 Year Containment Sump Integrity Test Report (Low Level Method)
413 Medical Waste Storage Facility Permit Application
009 Alabama Recycling Fund Grant Application
317 Alabama Hazardous Waste/Used Oil Transporter Permit Application
414 Monthly Statistical Inventory Reconciliation (SIR) Report
439 Permit Application Solid Waste Disposal Facility
478 UST Natural Attenuation Monitoring Report Form
541 Scrap Tire Site Registration
557 3 Year Containment Sump Integrity Test Report
571 Beneficial Use Annual Reporting
323 Alternative Medical Waste Treatment Technology Equipment Approval Application
479 UST Release Fact Sheet
542 Brownfields State Revolving Fund PreApplication Form
016 Annual Recycling Report (for use by State Agencies/Departments and Schools ONLY)
031 Alabama Tank Trust Fund Cost Proposal Part 1
558 30 Day Walkthrough Inspection Checklist Log
460 Statistical Inventory Reconciliation SIR 7 Day Release Investigation Notice Form
480 UST Release Report Form
543 Brownfields State Revolving Fund Application Fund
302 SARA Title III Section 302 Notification
032 Alabama Tank Trust Fund Payment Request
559 3 Year Overfill Prevention Equipment Inspection Report
326 Annual Statistical Inventory Reconciliation (SIR) Report Form
407 SARA Title III Section 311: SDS/MSDS Reporting
481 UST Site Classification System Checklist
545 Cathodic Protection Monitoring for Galvanic Systems
560 Annual Probe and Sensor Test Report
330 Application for Name Change or Transfer of Scrap Tire Permit
462 Tank Trust Fund Eligibility/Ineligibility Determination Form
482 UST System Effectiveness Monitoring Report Form
546 Alabama Hazardous Waste Receipt for Samples and Documents
015 Processing and Recycling General Information
561 Annual Release Detection Equipment Testing Log
483 UST Tracer Tank Tightness Test Report Form
521 Voluntary Cleanup Program Application Form
019 Annual Walkthrough Inspection Log
562 Compatibility Demonstration Log
278 Disposal Approval Request
332 Cathodic Protection Monitoring Form for Impressed Current Systems
400 Impressed Current Cathodic Protection System 60-Day Inspection Log
484 UST Ullage Tank Tightness Test Report Form
020 Spill Catchment Basin/Spill Bucket 3 Year Test Log
563 Manual Tank Gauging Monthly Log
279 Notification for Underground Storage Tanks
403 Interior Lining Inspection Form
485 UST Vacuum Tank Tightness Test Report Form
530 Technical Proposal for Qualification as a Scrap Tire Fund Remediation Contractor
550 Brownfields Assessment Request Application
564 Annual Liquid Sensor Inspection and Functionality Test
283 Notification for Above Ground Storage Tanks
404 Interior Lining Report Form
422 Notice of Intent to Permanently Close Underground Storage Tanks
469 Underground and Above Ground Storage Tank Transfer of Ownership
486 UST Volumetric Overfill Tank Tightness Test Report Form
551 ADEM Line Leak Detector (LLD) Test Report Form
565 ADEM Annual Tank Gauge Test Report
300 Solid Waste Profile Sheet
423 Notice of Proposed UST New Installation or Upgrade
471 UST ARBCA Tier 1 Report Forms
487 UST Volumetric Underfill Tank Tightness Test Report Form
8700-12 Notification of Regulated Waste Activity
566 ADEM Automatic Line Leak Detector and Line Tightness Test Report
406 Manual Interstitial Monitoring Monthly Log
425 Notification of Election of Coverage under The Alabama Drycleaning Environmental Response Trust Fund Act
472 UST ARBCA Tier 2 Report Forms
011 Solid Waste Landfill Operator Initial Certification Application
018 Composting Facility Application
310 Notice of Temporary Closure
473 UST ARBCA Tier 3 Report Forms
012 Solid Waste Landfill Operator Reciprocal Certification Application
568 Application for Facility Name Change or Transfer of Solid Waste Disposal Facility Permit
474 UST Closure Site Assessment Report Form
536 Scrap Tire Manifest
013 Solid Waste Landfill Operator Certification Renewal
569 Beneficial Use Facility Registration Application
410 Medical Waste Notification Form
475 UST Free Product Recovery Report Form
537 Scrap Tire Registration & Exemption Application
411 Medical Waste Transporter Permit Application
476 UST Groundwater Monitoring Report Form
492 UST Closure Total Potential Voc Emissions Calculations
538 Scrap Tire Transporter Permit Application
412 Medical Waste Treatment Permit Application
477 UST Line Tightness Test Report Form
539 Scrap Tire Quarterly Report
531 Hydrogeology Unit Evaluation Report Form
Division: Water
Form # Form Name
243 Drinking Water - Monthly Membrane Surface Plant Operational Data Report
029 NPDES Pesticide Adverse Incident Report Form
188 NPDES Individual Permit Application Supplementary Information for Publicly-Owned Treatment Works (POTW), Other Treatment Works Treating Domestic Sewage (TWTDS), and Public Water Supply Treatment Plants
392 Notice of Intent - NPDES General Permit Number ALG280000
344 Coalbed Methane Temporary Pit Wastewater Land Application Certification Report
458 SID Discharge Monitoring Report Form (Quarterly)
516 Supplemental Petroleum Application Information
014 Information Needed for 316(b) Determination in Regards to General NPDES Permits
030 Notice of Termination - General Permit Number ALG870000
193 Application For Alabama Well Driller's License
393 Notice of Intent - NPDES General Permit Number ALG030000
415 Sanitary Sewer Overflow (SSO) Event Reporting Form
376 Field Operation Division NPDES Individual Permit Application Addendum Form
459 SRF Payment Request Form
517 Alabama Clean Vessel Act Grant Application
060 Drinking Water - Notification of Intent to Drill a Water Well
324 Annual Certification Form for Discharges Associated with Petroleum Storage and Handling Areas
394 Notice of Intent - NPDES General Permit Number ALG340000
416 Municipal Water Pollution Prevention (MWPP) Annual Report (Collection Systems) Package
441 Plant and Collection System Personnel Inventory
377 Field Operation Division NPDES Individual Permit Application Minor Permit Modification Addendum Form
518 Boating Infrastructure Grant Application
395 Notice of Intent - NPDES General Permit Number ALG360000
417 Municipal Water Pollution Prevention (MWPP) Annual Report Package
442 Drinking Water - Laboratory Certification Application
461 Drinking Water - Surface Source Susceptibility Analysis Worksheet
498 Notice of Intent - NPDES General Permit Number ALG890000
033 eDWRS Permittee Registration Form
242 Drinking Water - Filter Plant Monthly Operational Data Report
380 Notice of Intent - NPDES General Permit Number ALG110000
396 Notice of Intent - NPDES General Permit Number ALG060000
418 Municipal Water Pollution Prevention Resolution Form
443 Drinking Water - Construction Project Update
429 NPDES Annual Notice of Registration (NOR)
499 Notice of Termination - NPDES General Permit Number ALG890000
520 General Phase II MS4 Stormwater Permit Renewal Notice of Intent
034 eDWRS Lab Registration Form
259 Drinking Water - Application for Approval to Use a Water Supply Well
381 Notice of Intent - NPDES General Permit Number ALG120000
397 Notice of Intent - NPDES General Permit Number ALG670000
419 MWPP Sewage Sludge Survey
444 Drinking Water - Project Completion Form
432 NPDES Individual Permit Pollution Abatement/Treatment Measures and Sediment Control Structures Certification Report
464 Toxicity Discharge Monitoring Report Form
500 NPDES Noncoal/Nonmetallic Mining and Dry Processing Less than Five Acres Stormwater Inspection Report and BMP Certification
547 Drinking Water - WTP Quarterly Report for the Disinfectants and Disinfection Byproducts Rule
035 eDWRS Terms and Conditions Agreement
382 Notice of Intent - NPDES General Permit Number ALG140000
420 Drinking Water - Non-Community Public Notification Certification Form
446 Raw Sewage Bypass and Overflow Event Reporting Form
433 NPDES Permitted Coalbed Methane Operations Pollution Abatement/Treatment Measures and Waste Treatment Facilities Certification Report
465 Toxicity Test Report Summary
501 ALG890000 Small Mining General Permit Noncompliance Notification Report Form
522 Notice of Intent - NPDES General Permit Number ALG640000
549 NPDES Coalbed Methane Operation
021 Termination Request - General Permit Number ALR100000
335 Drinking Water - Chemical Monitoring Data Report
383 Notice of Intent - NPDES General Permit Number ALG150000
421 NPDES/SID Non-Compliance Notification Form
447 Release Information Form
466 NPDES/SID/UIC Permit Transfer Agreement
022 NPDES General Permit ALR100000
036 Drinking Water - Total Coliform Rule - Level 1 Assessment
336 Drinking Water - Chemical Monitoring Waiver Application
384 Notice of Intent - NPDES General Permit Number ALG160000
451 Request for NPDES Permit Post-Mining Discharge Limitations (Coal Mining Operations)
503 General Permit for Phase II Small Municipal Separate Storm Sewer Systems (MS4) ALNOI
023 NPDES Construction Stormwater Inspection Report and BMP Certification
037 Drinking Water - Total Coliform Rule - Level 2 Assessment
339 Clean Water State Revolving Fund (CWSRF) Loan Application Form
385 Notice of Intent - NPDES General Permit Number ALG170000
405 Drinking Water - Lead and Copper Monitoring Data Report
452 Request for Release from NPDES Permit Monitoring and Reporting Requirements (Mining Operations)
505 Water and Wastewater Operator Exam Application
024 Notice of Intent - General Permit Number ALR100000
189 Permit Application for Reclaimed Water Use (RWR)
340 Clean Water State Revolving Fund (CWSRF) Preapplication Form
386 Notice of Intent - NPDES General Permit Number ALG180000
315 NPDES Individual Permit Application (Mining Operations)
453 Request to Remove Subsurface Withdrawal From Discharge Structure (NPDES-Permitted Mining Operations)
488 Drinking Water - Construction Permit Application
506 Water and Wastewater Operator Experience Verification
533 Documentation of Disability Related Needs
567 NPDES Mining and Preparation Plant Outfall Data for Metals, Cyanide, and Total Phenols
345 Drinking Water - Community Public Notification Certification Form
387 Notice of Intent - NPDES General Permit Number ALG020000
408 Drinking Water - Maximum Residual Disinfectant Level Input Form (Samples)
454 Request to Remove Treatment Basin/Pond or Other Discharge Structure (NPDES-Permitted Mining Operations)
489 Drinking Water - Modification Permit Application
507 Water and Wastewater Reciprocal Application
535 Drinking Water - Giardia and Virus Profile Spreadsheet
025 NPDES Construction Stormwater Noncompliance Notification Report
552 Notice of Intent - UIC General Permit Number ALIG010000
311 Alternative Analysis
346 Drinking Water - Community System Susceptibility Analysis Sheet
388 Notice of Intent - NPDES General Permit Number ALG200000
409 Maximum Residual Disinfectant Level Input Form (Sources)
435 Operator Certification Renewal Form
450 Representative Stormwater Outfall Certification
490 Drinking Water - Renewal Permit Application
508 Water and Wastewater Operator for Multiple Systems
026 Notice of Intent - NPDES General Permit Number ALG850000
553 Notice of Intent - UIC General Permit Number ALIG020000
185 Drinking Water - Purchase Water System Monthly Operation Report
312 Calculation of Total Annualized Project Cost for Public - Sector Projects
369 Drinking Water State Revolving Fund (DWSRF) Loan Application Form
389 Notice of Intent - NPDES General Permit Number ALG230000
455 Required Information for Mixing Zone Modeling
491 Drinking Water - Public Water System Information Update
510 Cooling Water Supplemental Information
194 Water Well Driller Reciprocal Application
027 Drinking Water - Operational Evaluation Level Exceedance Report
554 Notice of Termination - NPDES General Permits (Industrial Activities)
347 Drinking Water - Consumer Confidence Report (CCR) Certification Report
186 State Indirect Discharge (SID) Permit Application
313 Calculation of Total Annualized Project Cost for Private - Sector Projects
370 Drinking Water State Revolving Fund (DWSRF) Preapplication Form
390 Notice of Intent - NPDES General Permit Number ALG240000
456 Segmental Water System Certification Application
514 Daily Discharge Monitor Report
195 Water Well Standards Program License Renewal
028 Notice of Intent - General Permit Number ALG870000
555 No Exposure Certification for Exclusion from NPDES Stormwater Permitting for Industrial Activities
570 One-Time Compliance Report for Dental Discharges
008 Drinking Water - Groundwater System Monthly Operational Data Report
187 NPDES Individual Permit Application Supplementary Information for Industrial Facilities
314 ADEM Baseline Monitoring Report Submittal Form
391 Notice of Intent - NPDES General Permit Number ALG250000
343 Coalbed Methane Stormwater Inspection Summary Report
457 SID Discharge Monitoring Report Form (Monthly)
515 Monthly Discharge Monitoring Report
531 Hydrogeology Unit Evaluation Report Form