Departmental Forms

ALABAMA
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT

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Departmental Forms

This quick list of departmental forms are in a pdf. format. If you are looking for other types of formats pertaining to these forms such as word, excel, etc. please see the different division areas listed.

This list is detailed by number of the form.

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Form Number	Form Name PDF Version	Form Name Word or Excel Version	Division
8	Groundwater System Monthly Operational Data Report	Groundwater System Monthly Operational Data Report	Water
52	Registration Form for the Construction, Installation, or Modification of an Incinerator	Registration Form for the Construction, Installation, or Modification of an Incinerator	Air
60	Notification of Intent to Drill a Water Well	Notification of Intent to Drill a Water Well (This form is not available in a Word or Excel Format)	Water
103	Operating Permit Application Facility Identification Form	Operating Permit Application Facility Identification Form	Air
104	Permit Application for Indirect Heating Equipment	Permit Application for Indirect Heating Equipment	Air
105	Permit Application for Manufacturing or Processing Operation	Permit Application for Manufacturing or Processing Operation	Air
106	Permit Application for Waste Disposal	Permit Application for Waste Disposal	Air
107	Permit Application for Stationary Internal Combustion Engines	Permit Application for Stationary Internal Combustion Engines	Air
108	Permit Application for Loading and Storage of Organic Compounds	Permit Application for Loading and Storage of Organic Compounds	Air
109	Permit Application for Volatile Organic Compound Surface Coating Emission Source	Permit Application for Volatile Organic Compound Surface Coating Emission Source	Air
110	Permit Application for Air Pollution Control Device	Permit Application for Air Pollution Control Device	Air
112	Permit Application for Solvent Metal Cleaning	Permit Application for Solvent Metal Cleaning	Air
166	Joint Application and Notification U. S. Department of Army, Corps of Engineers Alabama Department of Environmental Management	Joint Application and Notification U. S. Department of Army, Corps of Engineers Alabama Department of Environmental Management	Field Operations
184	Seal Gap Test Form	Seal Gap Test Form	Air
185	Purchase Water System Monthly Operation Report	Purchase Water System Monthly Operation Report	Water
186	State Indirect Permit Application	State Indirect Permit Application	Water
187	NPDES Permit Application Supplementary Information	NPDES Permit Application Supplementary Information	Water
188	NPDES Permit Application Semi-Public and Private Facilities	NPDES Permit Application Semi-Public and Private Facilities	Water
193	Application For Alabama Well Driller's License	Application For Alabama Well Driller's License (This form is not available in a Word or Excel Format)	Water
197	Air Permit Application for Gasoline Dispensing Facilities	Air Permit Application for Gasoline Dispensing Facilities	Air
198	Gasoline Transport Tank Truck Application	Gasoline Transport Tank Truck Application	Air
242	Filter Plant Monthly Operational Data Report	Filter Plant Monthly Operational Data Report	Water
257	Stabilization Lagoon Inspection Report	Stabilization Lagoon Inspection Report	Field Operations
259	Application for Approval to Use a Water Supply Well	Application for Approval to Use a Water Supply Well	Water
278	Disposal Approval Request	Disposal Approval Request	Land
279	Notification for Underground Storage Tanks	Notification for Underground Storage Tanks	Water
283	Notification for Above Ground Storage Tanks	Notification for Above Ground Storage Tanks	Water
300	Solid Waste Profile Sheet	Solid Waste Profile Sheet	Land
305	Permit Application Solid Waste Disposal Facility Construction/Demolition Landfill	Permit Application Solid Waste Disposal Facility Construction/Demolition Landfill	Land
309	Cargo Tank Tightness Test Report	Cargo Tank Tightness Test Report	Air
310	Notice of Temporary Closure	Notice of Temporary Closure	Water
311	Alternative Analysis	Alternative Analysis	Water
312	Calculation of Total Annualized Project Cost for Public-Sector Projects	Calculation of Total Annualized Project Cost for Public-Sector Projects	Water
313	Calculation of Total Annualized Project Cost for Private – Sector Projects	Calculation of Total Annualized Project Cost for Private – Sector Projects	Water
314	ADEM Baseline Monitoring Report Submittal Form	ADEM Baseline Monitoring Report Submittal Form	Water
315	ADEM Field Operation Division NPDES Individual Permit Application	ADEM Field Operation Division NPDES Individual Permit Application	Field Operations
316	Alabama Coastal Area Management Program Application for Approval of a Non-Regulated Use ADEM Adminst4rative Code Rule 335-8-1-.11 Groundwater Extraction 50 GPM or Greater	Alabama Coastal Area Management Program Application for Approval of a Non-Regulated Use ADEM Adminst4rative Code Rule 335-8-1-.11 Groundwater Extraction 50 GPM or Greater	Field Operations
317	Alabama Hazardous Waste/Used Oil Transporter Permit Application	Alabama Hazardous Waste/Used Oil Transporter Permit Application	Land
318	Alabama Tank Trust Fund Cost Proposal Form	Alabama Tank Trust Fund Cost Proposal Form	Water
319	Alabama Tank Trust Fund Payment Request Form	Alabama Tank Trust Fund Payment Request Form	Water
320	ALG610000 & ALG490000 Authorization Termination Request and Certification This form is replaced by Form # 499	ALG610000 & ALG490000 Authorization Termination Request and Certification This form is replaced by Form # 499	Field Operations
321	ALG610000 & ALG490000 Inspection Report and BMP Certification This form is replaced by Form # 500	ALG610000 & ALG490000 Inspection Report and BMP Certification This form is replaced by Form # 500	Field Operations
322	ALG610000 & ALG490000 Noncompliance Notification Report This form is replaced by Form # 501	ALG610000 & ALG490000 Noncompliance Notification Report This form is replaced by Form # 501	Field Operations
323	Alternative Medical Waste Treatment Technology Equipment Approval Application	Alternative Medical Waste Treatment Technology Equipment Approval Application	Land
324	Annual Certification Form for Discharges Associated with Petroleum Storage and Handling Areas	Annual Certification Form for Discharges Associated with Petroleum Storage and Handling Areas	Water
325	Annual Compliance Statement Form	Annual Compliance Statement Form	Air
326	Annual Statistical Inventory Reconciliation (SIR) Report Form	Annual Statistical Inventory Reconciliation (SIR) Report Form	Water
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	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	Field Operations
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	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	Field Operations
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	Application for Approval of a Non-Regulated Use in the Alabama Coastal Area Developments and Subdivisions of Property Greater then 5 Acres in Size	Field Operations
330	Application for Name Change or Transfer of Permit Solid Waste Disposal Facility	Application for Name Change or Transfer of Permit Solid Waste Disposal Facility	Land
331	Bulk (Gasoline) Plant Application	Bulk (Gasoline) Plant Application	Air
332	Cathodic Protection Monitoring Form for Impressed Current Systems	Cathodic Protection Monitoring Form for Impressed Current Systems	Water
333	CBM NPDES Stormwater Discharge Monitoring Report	CBM NPDES Stormwater Discharge Monitoring Report	Field Operations
334	CBM Toxicity Test Report Summary	CBM Toxicity Test Report Summary	Field Operations
335	Chemical Monitoring Data Report	Chemical Monitoring Data Report	Water
336	Chemical Monitoring Waiver Application	Chemical Monitoring Waiver Application	Water
337	Chemical Sampling Chain of Custody Form	Chemical Sampling Chain of Custody Form	Water
338	Clean Water State Revolving Fund (CWSRF) Construction Report Form	Clean Water State Revolving Fund (CWSRF) Construction Report Form (This form is not available in a Word or Excel Format)	Water
339	Clean Water State Revolving Fund (CWSRF) Loan Application Form	Clean Water State Revolving Fund (CWSRF) Loan Application Form	Water
340	Clean Water State Revolving Fund (CWSRF) Preapplication Form	Clean Water State Revolving Fund (CWSRF) Preapplication Form	Water
341	Clean Water State Revolving Fund (CWSRF) Supplemental General Conditions	Clean Water State Revolving Fund (CWSRF) Supplemental General Conditions	Water
342	Coal Permit Precipitation Event Discharge Limitations Exemption Claim Report	Coal Permit Precipitation Event Discharge Limitations Exemption Claim Report	Field Operations
343	Coalbed Methane Stormwater Inspection Summary Report	Coalbed Methane Stormwater Inspection Summary Report	Field Operations
344	Coalbed Methane Temporary Pit Wastewater Land Application Certification Report	Coalbed Methane Temporary Pit Wastewater Land Application Certification Report	Field Operations
345	Community Public Notification Certification Form	Community Public Notification Certification Form	Water
346	Community System Susceptibility Analysis Sheet	Community System Susceptibility Analysis Sheet	Water
347	Consumer Confidence Report Certification Form	Consumer Confidence Report Certification Form	Water
348	Discharge Monitoring Report for CBM Coal – Type 60 Effluent Example	Discharge Monitoring Report for CBM Coal – Type 60 Effluent (This form is not available in a Word or Excel Format)	Field Operations
349	Discharge Monitoring Report for CBM Coal – Type 60 Manual Example	Discharge Monitoring Report for CBM Coal – Type 60 Manual (This form is not available in a Word or Excel Format)	Field Operations
350	Discharge Monitoring Report for CBM Coal – Type 60 Standard Example	Discharge Monitoring Report for CBM Coal – Type 60 Standard (This form is not available in a Word or Excel Format)	Field Operations
351	Discharge Monitoring Report for Coal – Type 1 & Type 3 Example	Discharge Monitoring Report for Coal – Type 1 & Type 3 (This form is not available in a Word or Excel Format)	Field Operations
352	Discharge Monitoring Report for Coal – Type 11 Example	Discharge Monitoring Report for Coal – Type 11 (This form is not available in a Word or Excel Format)	Field Operations
353	Discharge Monitoring Report for Coal – Type 13 Example	Discharge Monitoring Report for Coal – Type 13 (This form is not available in a Word or Excel Format)	Field Operations
354	Discharge Monitoring Report for Coal – Type 14 Sand & Gravel Example	Discharge Monitoring Report for Coal – Type 14 Sand & Gravel (This form is not available in a Word or Excel Format)	Field Operations
355	Discharge Monitoring Report for Coal – Type 14 Fire Clay Example	Discharge Monitoring Report for Coal – Type 14 Fire Clay (This form is not available in a Word or Excel Format)	Field Operations
356	Discharge Monitoring Report for Coal – Type 14 Shale – Common Clay Example	Discharge Monitoring Report for Coal – Type 14 Shale – Common Clay (This form is not available in a Word or Excel Format)	Field Operations
357	Discharge Monitoring Report for Coal – Type 15 Example	Discharge Monitoring Report for Coal – Type 15 (This form is not available in a Word or Excel Format)	Field Operations
358	Discharge Monitoring Report for Coal – Type 38 Example	Discharge Monitoring Report for Coal – Type 38 (This form is not available in a Word or Excel Format)	Field Operations
359	Discharge Monitoring Report for Coal – Type 5 & Type 7 Example	Discharge Monitoring Report for Coal – Type 5 & Type 7 (This form is not available in a Word or Excel Format)	Field Operations
360	Discharge Monitoring Report for Coal – Type 9 Example	Discharge Monitoring Report for Coal – Type 9 (This form is not available in a Word or Excel Format)	Field Operations
361	Discharge Monitoring Report for NonCoal – Type 30 Example	Discharge Monitoring Report for NonCoal – Type 30 (This form is not available in a Word or Excel Format)	Field Operations
362	Discharge Monitoring Report for NonCoal – Type 32 Example	Discharge Monitoring Report for NonCoal – Type 32 (This form is not available in a Word or Excel Format)	Field Operations
363	Discharge Monitoring Report for NonCoal – Type 34 Example	Discharge Monitoring Report for NonCoal – Type 34 (This form is not available in a Word or Excel Format)	Field Operations
364	Discharge Monitoring Report for NonCoal – Type 36 & Type 48 & Type 50 Example	Discharge Monitoring Report for NonCoal – Type 36 & Type 48 & Type 50 (This form is not available in a Word or Excel Format)	Field Operations
365	Discharge Monitoring Report for NonCoal – Type 41 Example	Discharge Monitoring Report for NonCoal – Type 41 (This form is not available in a Word or Excel Format)	Field Operations
366	Discharge Monitoring Report for NonCoal – Type 42 Example	Discharge Monitoring Report for NonCoal – Type 42 (This form is not available in a Word or Excel Format)	Field Operations
367	Discharge Monitoring Report for NonCoal – Type 44 & Type 45 Example	Discharge Monitoring Report for NonCoal – Type 44 & Type 45 (This form is not available in a Word or Excel Format) Example	Field Operations
368	Discharge Monitoring Report for NonCoal – Type 46 Example	Discharge Monitoring Report for NonCoal – Type 46 (This form is not available in a Word or Excel Format) Example	Field Operations
369	Drinking Water State Revolving Fund (DWSRF) Loan Application Form	Drinking Water State Revolving Fund (DWSRF) Loan Application Form	Water
370	Drinking Water State Revolving Fund (DWSRF) Preapplication Form	Drinking Water State Revolving Fund (DWSRF) Preapplication Form	Water
371	Drinking Water State Revolving Fund (DWSRF) Supplemental General Conditions	Drinking Water State Revolving Fund (DWSRF) Supplemental General Conditions (This form is not available in a Word or Excel Format)	Water
372	Emissions Statement Reporting Form (For Shelby County Facilities Only)	Emissions Statement Reporting Form (For Shelby County Facilities Only)	Air
373	Excess Emission Monitoring Report	Excess Emission Monitoring Report	Air
374	Exemption Claim Form for Cofired Combustors (Appendix H - Division 3)	Exemption Claim Form for Cofired Combustors (Appendix H - Division 3)	Air
375	Exemption Claim Form For Incinerators Burning Only Pathological, Low-Level Radioactive, and Chemotherapeutic Waste (Appendix H - Division 3)	Exemption Claim Form For Incinerators Burning Only Pathological, Low-Level Radioactive, and Chemotherapeutic Waste (Appendix H - Division 3)	Air
376	Field Operation Division NPDES Individual Permit Application Addendum Form	Field Operation Division NPDES Individual Permit Application Addendum Form	Field Operations
377	Field Operation Division NPDES Individual Permit Application Minor Permit Modification Addendum Form	Field Operation Division NPDES Individual Permit Application Minor Permit Modification Addendum Form	Field Operations
378	Gasoline Dispensing Facility Information Survey	Gasoline Dispensing Facility Information Survey	Air
379	General Permit Application Form – NOI-61 & 49 This form is replaced by Form # 498	General Permit Application Form – NOI-61 & 49 This form is replaced by Form # 498	Field Operations
380	General Permit Application Package – NOI-11	General Permit Application Package – NOI-11	Water
381	General Permit Application Package – NOI-12	General Permit Application Package – NOI-12	Water
382	General Permit Application Package – NOI-14	General Permit Application Package – NOI-14	Water
383	General Permit Application Package – NOI-15	General Permit Application Package – NOI-15	Water
384	General Permit Application Package – NOI-16	General Permit Application Package – NOI-16	Water
385	General Permit Application Package – NOI-17	General Permit Application Package – NOI-17	Water
386	General Permit Application Package – NOI-18	General Permit Application Package – NOI-18	Water
387	General Permit Application Package – NOI-2	General Permit Application Package – NOI-2	Water
388	General Permit Application Package – NOI-20	General Permit Application Package – NOI-20	Water
389	General Permit Application Package – NOI-23	General Permit Application Package – NOI-23	Water
390	General Permit Application Package – NOI-24	General Permit Application Package – NOI-24	Water
391	General Permit Application Package – NOI-25	General Permit Application Package – NOI-25	Water
392	General Permit Application Package – NOI-28	General Permit Application Package – NOI-28	Water
393	General Permit Application Package – NOI-3	General Permit Application Package – NOI-3	Water
394	General Permit Application Package – NOI-34	General Permit Application Package – NOI-34	Water
395	General Permit Application Package – NOI-36	General Permit Application Package – NOI-36	Water
396	General Permit Application Package – NOI-6	General Permit Application Package – NOI-6	Water
397	General Permit Application Package – NOI-67	General Permit Application Package – NOI-67	Water
398	General Permit Renewal Form	General Permit Renewal Form	Water
399	Hydrograph Control Release (HCR) Attachment	Hydrograph Control Release (HCR) Attachment	Water
400	Impressed Current Cathodic Protection System 60-Day Inspection Log	Impressed Current Cathodic Protection System 60-Day Inspection Log	Water
401	Individual NPDES Permit Noncompliance Notification (5-day Report)	Individual NPDES Permit Noncompliance Notification (5-day Report)	Field Operations
403	Interior Lining Inspection Form	Interior Lining Inspection Form	Water
404	Interior Lining Report Form	Interior Lining Report Form	Water
405	Lead and Copper Monitoring Data Report	Lead and Copper Monitoring Data Report	Water
406	Manual Interstitial Monitoring Monthly Log	Manual Interstitial Monitoring Monthly Log	Water
407	Material Safety Data Sheet Reporting	Material Safety Data Sheet Reporting	Field Operations
408	Maximum Residual Disinfectant Level Input Form (Samples)	Maximum Residual Disinfectant Level Input Form (Samples)	Water
409	Maximum Residual Disinfectant Level Input Form (Sources)	Maximum Residual Disinfectant Level Input Form (Sources)	Water
410	Medical Waste Notification Form	Medical Waste Notification Form	Land
411	Medical Waste Transporter Permit Application	Medical Waste Transporter Permit Application	Land
412	Medical Waste Treatment Permit Application	Medical Waste Treatment Permit Application	Land
414	Monthly Statistical Inventory Reconciliation (SIR) Report	Monthly Statistical Inventory Reconciliation (SIR) Report	Water
415	Municipal POTW SSO/MS4 Event Reporting Form	Municipal POTW SSO/MS4 Event Reporting Form	Water
416	Municipal Water Pollution Prevention (MWPP) Annual Report (Collection Systems) Package	Municipal Water Pollution Prevention (MWPP) Annual Report (Collection Systems) Package	Water
417	Municipal Water Pollution Prevention (MWPP) Annual Report Package	Municipal Water Pollution Prevention (MWPP) Annual Report Package	Water
418	Municipal Water Pollution Prevention Resolution Form	Municipal Water Pollution Prevention Resolution Form	Water
419	MWPP Sewage Sludge Survey	MWPP Sewage Sludge Survey	Water
420	Non-Community Public Notification Certification Form	Non-Community Public Notification Certification Form	Water
421	Non-Compliance Report Form	Non-Compliance Report Form	Water
422	Notice of Intent to Permanently Close Underground Storage Tanks	Notice of Intent to Permanently Close Underground Storage Tanks	Water
423	Notice of Proposed UST New Installation or Upgrade	Notice of Proposed UST New Installation or Upgrade	Water
424	Notification – Above the Threshold Planning Quantities (TPQ) of Extremely Hazardous Substances	Notification – Above the Threshold Planning Quantities (TPQ) of Extremely Hazardous Substances	Field Operations
425	Notification of Election of Coverage under The Alabama Drycleaning Environmental Response Trust Fund Act	Notification of Election of Coverage under The Alabama Drycleaning Environmental Response Trust Fund Act	Land
426	Nox Budget Permit Application Form	Nox Budget Permit Application Form	Air
427	Nox Budget Retired Unit Exemption Claim Form	Nox Budget Retired Unit Exemption Claim Form	Air
429	NPDES Annual Notice of Registration (NOR) This form is for CAFO Registration	NPDES Annual Notice of Registration (NOR) This form is for CAFO Registration	Field Operations
430	NPDES Discharge Monitoring Report Form (Monthly)	NPDES Discharge Monitoring Report Form (Monthly)	Water
431	NPDES Discharge Monitoring Report Form (Quarterly)	NPDES Discharge Monitoring Report Form (Quarterly)	Water
432	NPDES Individual Permit Pollution Abatement / Treatment Measures and Sediment Control Structures Certification Report	NPDES Individual Permit Pollution Abatement / Treatment Measures and Sediment Control Structures Certification Report	Field Operations
433	NPDES Permitted Coalbed Methane Operations Pollution Abatement/Treatment Measures and Waste Treatment Facilities Certification Report	NPDES Permitted Coalbed Methane Operations Pollution Abatement/Treatment Measures and Waste Treatment Facilities Certification Report	Field Operations
434	Open Burning Incident Report	Open Burning Incident Report	Air
435	Operator Certification Renewal Form (This form is not available in a Word Format)	Operator Certification Renewal Form	Water
436	Perc Dry Cleaner Status Update	Perc Dry Cleaner Status Update	Air
437	Permit Application for Compliance Schedule	Permit Application for Compliance Schedule	Air
438	Permit Application for Continuous Emission Monitoring Systems (CEMS)	Permit Application for Continuous Emission Monitoring Systems (CEMS)	Air
439	Permit Application Solid Waste Disposal Facility	Permit Application Solid Waste Disposal Facility	Land
440	Petroleum Solvent Dry Cleaning Questionnaire	Petroleum Solvent Dry Cleaning Questionnaire	Air
441	Plant and Collection System Personnel Inventory	Plant and Collection System Personnel Inventory	Water
442	Potable Water Laboratory Certification Application	Potable Water Laboratory Certification Application	Water
443	Progress Report Form	Progress Report Form	Water
444	Project Completion Form	Project Completion Form	Water
445	PSD Project Information Form	PSD Project Information Form	Air
446	Raw Sewage Bypass and Overflow Event Reporting Form	Raw Sewage Bypass and Overflow Event Reporting Form	Water
447	Release Information Form	Release Information Form	Field Operations
448	Remediation Approval Form	Remediation Approval Form	Air
449	Remediation Reporting Form	Remediation Reporting Form	Air
450	Representative Stormwater Outfall Certification	Representative Stormwater Outfall Certification	Water
451	Request for Coal Permit Post-Mining Discharge Limitations	Request for Coal Permit Post-Mining Discharge Limitations	Field Operations
452	Request for Release from Monitoring and Reporting Requirements	Request for Release from Monitoring and Reporting Requirements	Field Operations
453	Request to Remove Subsurface Withdrawal From Discharge Structure	Request to Remove Subsurface Withdrawal From Discharge Structure	Field Operations
454	Request to Remove Treatment Basin/Pond or Other Discharge Structure	Request to Remove Treatment Basin/Pond or Other Discharge Structure	Field Operations
455	Required Information for Mixing Zone Modeling	Required Information for Mixing Zone Modeling	Water
456	Segmental Water System Certification Application	Segmental Water System Certification Application	Water
457	SID Discharge Monitoring Report Form (Monthly)	SID Discharge Monitoring Report Form (Monthly)	Water
458	SID Discharge Monitoring Report Form (Quarterly)	SID Discharge Monitoring Report Form (Quarterly)	Water
459	SRF Payment Request Form	SRF Payment Request Form (This form is not available in a Word or Excel Format)	Water
460	Statistical Inventory Reconciliation SIR 7 Day Release Investigation Notice Form	Statistical Inventory Reconciliation SIR 7 Day Release Investigation Notice Form	Water
461	Surface Source Susceptibility Analysis Worksheet	Surface Source Susceptibility Analysis Worksheet	Water
462	Tank Trust Fund Eligibility / Ineligibility Determination Form	Tank Trust Fund Eligibility / Ineligibility Determination Form	Water
464	Toxicity Discharge Monitoring Report Form	Toxicity Discharge Monitoring Report Form	Water