Alabama Department of Environmental Management

For information concerning fees related to the forms below, please see the Fee Schedules located in ADEM Admin. Code r. 335-1-6-.07 – Payment of Fees.

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Air Program

Form #	Form Name
017	Specifications for Air Curtain Incinerators
039	MEME Vendor Application
052	Registration Form for the Construction, Installation, or Modification of an Incinerator
103	Operating Permit Application Facility Identification Form
104	Permit Application for Indirect Heating Equipment
105	Permit Application for Manufacturing or Processing Operation
106	Permit Application for Waste Disposal
107	Permit Application for Stationary Internal Combustion Engines
108	Permit Application for Loading and Storage of Organic Compounds
109	Permit Application for Volatile Organic Compound Surface Coating Emission Source
110	Permit Application for Air Pollution Control Device
112	Permit Application for Solvent Metal Cleaning
184	Seal Gap Test Form
197	Air Permit Application for Gasoline Dispensing Facilities
198	Gasoline Transport Tank Truck Application
309	Cargo Tank Tightness Test Report
331	Bulk (Gasoline) Plant Application
372	Emissions Statement Reporting Form (For Shelby County Facilities Only)
373	Excess Emission Monitoring Report
374	Exemption Claim Form for Cofired Combustors (Appendix H - Division 3)
375	Exemption Claim Form For Incinerators Burning Only Pathological, Low-Level Radioactive, and Chemotherapeutic Waste (Appendix H - Division 3)
378	Gasoline Dispensing Facility Information Survey
434	Open Burning Incident Report
436	Perc Dry Cleaner Status Update
437	Permit Application for Compliance Schedule
438	Permit Application for Continuous Emission Monitoring Systems (CEMS)
440	Petroleum Solvent Dry Cleaning Questionnaire
448	Remediation Approval Form
449	Remediation Reporting Form
493	112 (j) Part 1 Applicability Notification
494	Birmingham Fuel Supplier Report
496	Notice of Demolition and/or Asbestos Removal
497	Asbestos Removal Contractor Certification
502	Visible Emission Field Test Sheet
519	CAIR Permit Application

Coastal Program

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

Waste/Remediation/Underground Storage Tanks Program

Form #	Form Name
009	Alabama Recycling Fund Grant Application
011	Solid Waste Landfill Operator Initial Certification Application
012	Solid Waste Landfill Operator Reciprocal Certification Application
013	Solid Waste Landfill Operator Certification Renewal
015	Processing and Recycling General Information
016	Annual Recycling Report (for use by State Agencies/Departments and Schools ONLY)
018	Composting Facility Application
019	Annual Walkthrough Inspection Log
020	Spill Catchment Basin/Spill Bucket 3 Year Test Log
031	Alabama Tank Trust Fund Cost Proposal Part 1
032	Alabama Tank Trust Fund Payment Request
278	Disposal Approval Request
279	Notification for Underground Storage Tanks
283	Notification for Above Ground Storage Tanks
300	Solid Waste Profile Sheet
302	SARA Title III Section 302 Notification
310	Notice of Temporary Closure
317	Alabama Hazardous Waste/Used Oil Transporter Permit Application
323	Alternative Medical Waste Treatment Technology Equipment Approval Application
326	Annual Statistical Inventory Reconciliation (SIR) Report Form
330	Application for Name Change or Transfer of Scrap Tire Permit
332	Cathodic Protection Monitoring Form for Impressed Current Systems
400	Impressed Current Cathodic Protection System 60-Day Inspection Log
403	Interior Lining Inspection Form
404	Interior Lining Report Form
406	Manual Interstitial Monitoring Monthly Log
407	SARA Title III Section 311: SDS/MSDS Reporting
410	Medical Waste Notification Form
411	Medical Waste Transporter Permit Application
412	Medical Waste Treatment Permit Application
413	Medical Waste Storage Facility Permit Application
414	Monthly Statistical Inventory Reconciliation (SIR) Report
422	Notice of Intent to Permanently Close Underground Storage Tanks
423	Notice of Proposed UST New Installation or Upgrade
425	Notification of Election of Coverage under The Alabama Drycleaning Environmental Response Trust Fund Act
439	Permit Application Solid Waste Disposal Facility
460	Statistical Inventory Reconciliation SIR 7 Day Release Investigation Notice Form
462	Tank Trust Fund Eligibility/Ineligibility Determination Form
469	Underground and Above Ground Storage Tank Transfer of Ownership
471	UST ARBCA Tier 1 Report Forms
472	UST ARBCA Tier 2 Report Forms
473	UST ARBCA Tier 3 Report Forms
474	UST Closure Site Assessment Report Form
475	UST Free Product Recovery Report Form
476	UST Groundwater Monitoring Report Form
477	UST Line Tightness Test Report Form
478	UST Natural Attenuation Monitoring Report Form
479	UST Release Fact Sheet
480	UST Release Report Form
481	UST Site Classification System Checklist
482	UST System Effectiveness Monitoring Report Form
483	UST Tracer Tank Tightness Test Report Form
484	UST Ullage Tank Tightness Test Report Form
485	UST Vacuum Tank Tightness Test Report Form
486	UST Volumetric Overfill Tank Tightness Test Report Form
487	UST Volumetric Underfill Tank Tightness Test Report Form
492	UST Closure Total Potential Voc Emissions Calculations
521	Voluntary Cleanup Program Application Form
530	Technical Proposal for Qualification as a Scrap Tire Fund Remediation Contractor
536	Scrap Tire Manifest
537	Scrap Tire Registration & Exemption Application
538	Scrap Tire Transporter Permit Application
539	Scrap Tire Quarterly Report
540	Scrap Tire Processor Permit Application
541	Scrap Tire Site Registration
542	Brownfields State Revolving Fund PreApplication Form
543	Brownfields State Revolving Fund Application Fund
545	Cathodic Protection Monitoring for Galvanic Systems
546	Alabama Hazardous Waste Receipt for Samples and Documents
550	Brownfields Assessment Request Application
551	ADEM Line Leak Detector (LLD) Test Report Form
556	3 Year Containment Sump Integrity Test Report (Low Level Method)
557	3 Year Containment Sump Integrity Test Report
558	30 Day Walkthrough Inspection Checklist Log
559	3 Year Overfill Prevention Equipment Inspection Report
560	Annual Probe and Sensor Test Report
561	Annual Release Detection Equipment Testing Log
562	Compatibility Demonstration Log
563	Manual Tank Gauging Monthly Log
564	Annual Liquid Sensor Inspection and Functionality Test
565	ADEM Annual Tank Gauge Test Report
566	ADEM Automatic Line Leak Detector and Line Tightness Test Report
568	Application for Facility Name Change or Transfer of Solid Waste Disposal Facility Permit
569	Beneficial Use Facility Registration Application
571	Beneficial Use Annual Reporting
8700-12	Notification of Regulated Waste Activity

Water Program

Form #	Form Name
008	Drinking Water - Groundwater System Monthly Operational Data Report
014	Information Needed for 316(b) Determination in Regards to General NPDES Permits
021	Termination Request - General Permit Number ALR100000
022	NPDES General Permit ALR100000
023	NPDES Construction Stormwater Inspection Report and BMP Certification
024	Notice of Intent - General Permit Number ALR100000
025	NPDES Construction Stormwater Noncompliance Notification Report
026	Notice of Intent - NPDES General Permit Number ALG850000
027	Drinking Water - Operational Evaluation Level Exceedance Report
028	Notice of Intent - General Permit Number ALG870000
029	NPDES Pesticide Adverse Incident Report Form
030	Notice of Termination - General Permit Number ALG870000
033	eDWRS Permittee Registration Form
034	eDWRS Lab Registration Form
035	eDWRS Terms and Conditions Agreement
036	Drinking Water - Total Coliform Rule - Level 1 Assessment
037	Drinking Water - Total Coliform Rule - Level 2 Assessment
060	Drinking Water - Notification of Intent to Drill a Water Well
185	Drinking Water - Purchase Water System Monthly Operation Report
186	State Indirect Discharge (SID) Permit Application
187	NPDES Individual Permit Application Supplementary Information for Industrial Facilities
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
189	Permit Application for Reclaimed Water Use (RWR)
193	Application For Alabama Well Driller's License
194	Water Well Driller Reciprocal Application
195	Water Well Standards Program License Renewal
242	Drinking Water - Filter Plant Monthly Operational Data Report
243	Drinking Water - Monthly Membrane Surface Plant Operational Data Report
259	Drinking Water - Application for Approval to Use a Water Supply Well
311	Alternative Analysis
312	Calculation of Total Annualized Project Cost for Public - Sector Projects
313	Calculation of Total Annualized Project Cost for Private - Sector Projects
314	ADEM Baseline Monitoring Report Submittal Form
315	NPDES Individual Permit Application (Mining Operations)
324	Annual Certification Form for Discharges Associated with Petroleum Storage and Handling Areas
335	Drinking Water - Chemical Monitoring Data Report
336	Drinking Water - Chemical Monitoring Waiver Application
339	Clean Water State Revolving Fund (CWSRF) Loan Application Form
340	Clean Water State Revolving Fund (CWSRF) Preapplication Form
343	Coalbed Methane Stormwater Inspection Summary Report
344	Coalbed Methane Temporary Pit Wastewater Land Application Certification Report
345	Drinking Water - Community Public Notification Certification Form
346	Drinking Water - Community System Susceptibility Analysis Sheet
347	Drinking Water - Consumer Confidence Report (CCR) Certification Report
369	Drinking Water State Revolving Fund (DWSRF) Loan Application Form
370	Drinking Water State Revolving Fund (DWSRF) Preapplication Form
376	Field Operation Division NPDES Individual Permit Application Addendum Form
377	Field Operation Division NPDES Individual Permit Application Minor Permit Modification Addendum Form
380	Notice of Intent - NPDES General Permit Number ALG110000
381	Notice of Intent - NPDES General Permit Number ALG120000
382	Notice of Intent - NPDES General Permit Number ALG140000
383	Notice of Intent - NPDES General Permit Number ALG150000
384	Notice of Intent - NPDES General Permit Number ALG160000
385	Notice of Intent - NPDES General Permit Number ALG170000
386	Notice of Intent - NPDES General Permit Number ALG180000
387	Notice of Intent - NPDES General Permit Number ALG020000
388	Notice of Intent - NPDES General Permit Number ALG200000
389	Notice of Intent - NPDES General Permit Number ALG230000
390	Notice of Intent - NPDES General Permit Number ALG240000
391	Notice of Intent - NPDES General Permit Number ALG250000
392	Notice of Intent - NPDES General Permit Number ALG280000
393	Notice of Intent - NPDES General Permit Number ALG030000
394	Notice of Intent - NPDES General Permit Number ALG340000
395	Notice of Intent - NPDES General Permit Number ALG360000
396	Notice of Intent - NPDES General Permit Number ALG060000
397	Notice of Intent - NPDES General Permit Number ALG670000
405	Drinking Water - Lead and Copper Monitoring Data Report
408	Drinking Water - Maximum Residual Disinfectant Level Input Form (Samples)
409	Maximum Residual Disinfectant Level Input Form (Sources)
415	Sanitary Sewer Overflow (SSO) Event Reporting Form
416	Municipal Water Pollution Prevention (MWPP) Annual Report (Collection Systems) Package
417	Municipal Water Pollution Prevention (MWPP) Annual Report Package
418	Municipal Water Pollution Prevention Resolution Form
419	MWPP Sewage Sludge Survey
420	Drinking Water - Non-Community Public Notification Certification Form
421	NPDES/SID Non-Compliance Notification Form
429	NPDES Annual Notice of Registration (NOR)
432	NPDES Individual Permit Pollution Abatement/Treatment Measures and Sediment Control Structures Certification Report
433	NPDES Permitted Coalbed Methane Operations Pollution Abatement/Treatment Measures and Waste Treatment Facilities Certification Report
435	Operator Certification Renewal Form
441	Plant and Collection System Personnel Inventory
442	Drinking Water - Laboratory Certification Application
443	Drinking Water - Construction Project Update
444	Drinking Water - Project Completion Form
446	Raw Sewage Bypass and Overflow Event Reporting Form
447	Release Information Form
450	Representative Stormwater Outfall Certification
451	Request for NPDES Permit Post-Mining Discharge Limitations (Coal Mining Operations)
452	Request for Release from NPDES Permit Monitoring and Reporting Requirements (Mining Operations)
453	Request to Remove Subsurface Withdrawal From Discharge Structure (NPDES-Permitted Mining Operations)
454	Request to Remove Treatment Basin/Pond or Other Discharge Structure (NPDES-Permitted Mining Operations)
455	Required Information for Mixing Zone Modeling
456	Segmental Water System Certification Application
457	SID Discharge Monitoring Report Form (Monthly)
458	SID Discharge Monitoring Report Form (Quarterly)
459	SRF Payment Request Form
461	Drinking Water - Surface Source Susceptibility Analysis Worksheet
464	Toxicity Discharge Monitoring Report Form
465	Toxicity Test Report Summary
466	NPDES/SID Permit Transfer Agreement
488	Drinking Water - Construction Permit Application
489	Drinking Water - Modification Permit Application
490	Drinking Water - Renewal Permit Application
491	Drinking Water - Public Water System Information Update
498	Notice of Intent - NPDES General Permit Number ALG890000
499	Notice of Termination - NPDES General Permit Number ALG890000
500	NPDES Noncoal/Nonmetallic Mining and Dry Processing Less than Five Acres Stormwater Inspection Report and BMP Certification
501	ALG890000 Small Mining General Permit Noncompliance Notification Report Form
503	General Permit for Phase II Small Municipal Separate Storm Sewer Systems (MS4) ALNOI
505	Water and Wastewater Operator Exam Application
506	Water and Wastewater Operator Experience Verification
507	Water and Wastewater Reciprocal Application
508	Water and Wastewater Operator for Multiple Systems
510	Cooling Water Supplemental Information
514	Daily Discharge Monitor Report
515	Monthly Discharge Monitoring Report
516	Supplemental Petroleum Application Information
517	Alabama Clean Vessel Act Grant Application
518	Boating Infrastructure Grant Application
520	General Phase II MS4 Stormwater Permit Renewal Notice of Intent
522	Notice of Intent - NPDES General Permit Number ALG640000
531	Hydrogeology Unit Evaluation Report Form
533	Documentation of Disability Related Needs
535	Drinking Water - Giardia and Virus Profile Spreadsheet
547	Drinking Water - WTP Quarterly Report for the Disinfectants and Disinfection Byproducts Rule
549	NPDES Coalbed Methane Operation
552	Notice of Intent - UIC General Permit Number ALIG010000
553	Notice of Intent - UIC General Permit Number ALIG020000
554	Notice of Termination - NPDES General Permits (Industrial Activities)
555	No Exposure Certification for Exclusion from NPDES Stormwater Permitting for Industrial Activities
567	NPDES Mining and Preparation Plant Outfall Data for Metals, Cyanide, and Total Phenols
570	One-Time Compliance Report for Dental Discharges