Name of Forms | Form Number |
Title VI Complaint Form | 572 |
Air Program | |
Specifications for Air Curtain Incinerators M-1 | 17 |
MEME Vendor Application | 39 |
Registration Form for the Construction, Installation, or Modification of an Incinerator M-3 | 52 |
Operating Permit Application Facility Identification Form M-8 | 103 |
Permit Application for Indirect Heating Equipment M-4 | 104 |
Permit Application for Manufacturing or Processing Operation M-6 | 105 |
Permit Application for Waste Disposal M-3 | 106 |
Permit Application for Stationary Internal Combustion Engines M-8 | 107 |
Permit Application for Loading and Storage of Organic Compounds M-3 | 108 |
Permit Application for Volatile Organic Compound Surface Coating Emission Source M-4 | 109 |
Permit Application for Air Pollution Control Device M-5 | 110 |
Permit Application for Solvent Metal Cleaning M-2 | 112 |
Seal Gap Test Form M-2 | 184 |
Air Permit Application for Gasoline Dispensing Facilities M-6 | 197 |
Gasoline Transport Tank Truck Application M-4 | 198 |
Cargo Tank Tightness Test Report M-1 | 309 |
Bulk (Gasoline) Plant Application M-2 | 331 |
Emissions Statement Reporting Form M-1 | 372 |
Excess Emission Monitoring Report | 373 |
Exemption Claim Form for Cofired Combustors (Appendix H - Division 3) M-1 | 374 |
Exemption Claim Form for Incinerators Burning Only Pathological, Low-Level Radioactive, and Chemotherapeutic Waste (Appendix H - Division 3) M-1 | 375 |
Gasoline Dispensing Facility Information Survey M-1 | 378 |
Open Burning Incident Report | 434 |
Perc Dry Cleaner Status Update M-1 | 436 |
Permit Application for Compliance Schedule M-2 | 437 |
Permit Application for Continuous Emission Monitoring Systems (CEMS) M-1 | 438 |
Petroleum Solvent Dry Cleaning Questionnaire M-1 | 440 |
Remediation Approval Form M-2 | 448 |
Remediation Reporting Form M-2 | 449 |
112(j) Part 1 Applicability Notification | 493 |
Birmingham Fuel Supplier Report M-1 | 494 |
Notice of Demolition and/or Asbestos Removal M-1 | 496 |
Asbestos Removal Contractor Certification | 497 |
Visible Emission Field Test Sheet | 502 |
CAIR Permit Application (for sources covered under a CAIR SIP) | 519 |
Coastal Program | |
Joint Application and Notification U. S. Department of Army, Corps of Engineers Alabama Department of Environmental Management M-3 | 166 |
Alabama Coastal Area Management Program Application for Approval of a Non-Regulated Use ADEM Administrative Code rule 335-8-1-.11 Groundwater Extraction 50 PM or Greater M-1 | 316 |
Application for a Permit for the Construction for a Motel, Hotel, or Other Multi-Unit Development on a Property Intersected by the Construction Control Line in the Alabama Coastal Area M-1 | 327 |
Application for a Permit for the Construction of SingleFamily Dwellings, Duplexes, or Other Similar Structures on Properties Intersected by the Construction Control Line in the Alabama Coastal Area M-1 | 328 |
Application for Approval of a Non-Regulated Use in the Alabama Coastal Area Developments and Subdivisions of Property Greater than 5 Acres in Size M-1 | 329 |
Waste/Remediation Program | |
Alabama Recycling Fund Grant Application M-2 | 9 |
Solid Waste Landfill Operator Initial Certification Application | 11 |
Solid Waste Landfill Operator Reciprocal Certification Application | 12 |
Solid Waste Landfill Operator Certification Renewal | 13 |
Processing and Recycling General Information Recycling Registration M-2 | 15 |
Annual Recycling Report | 16 |
Composting Facility Application M-1 | 18 |
UST Annual Walkthrough Inspection Checklist Log M-3 | 19 |
UST 3 Year Spill Prevention Equipment (Spill Bucket) Integrity Test Report (Hydrostatic and Vacuum Method) M-3 | 20 |
UST Alabama Tank Trust Fund Cost Proposal Part I M-5 | 31 |
UST Alabama Tank Trust Fund Payment Request Part I M-5 | 32 |
Disposal Approval Request M-1 | 278 |
UST Notification for Underground Storage Tanks M-4 | 279 |
UST Notification for Above Ground Storage Tanks M-4 | 283 |
Solid Waste Profile Sheet M-3 | 300 |
SARA Title III Section 302: Extremely Hazardous Substance Notification M-1 | 302 |
Permit Application Solid Waste Disposal Facility Construction/Demolition Landfill M-2 | 305 |
UST Notice of Temporary Closure M-2 | 310 |
Alabama Hazardous Waste/Used Oil Transporter Permit Application M-2 | 317 |
Alternative Medical Waste Treatment Technology Equipment Approval Application | 323 |
UST Annual Statistical Inventory Reconciliation (SIR) Report Form M-2 | 326 |
Application for Name Change or Transfer of Permit or Exemption M-5 | 330 |
UST Cathodic Protection Monitoring Form M-2 | 332 |
UST Impressed Current Cathodic Protection System 60-Day Inspection Log M-1 | 400 |
UST Interior Lining Inspection Form | 403 |
UST Interior Lining Report Form | 404 |
UST Manual Interstitial Monitoring Monthly Log M-1 | 406 |
SARA Title III Section 311: SDS/MSDS Reporting M-1 | 407 |
Application for Medical Waste Generator Notification M-3 | 410 |
Medical Waste Transporter Permit Application M-5 | 411 |
Medical Waste Treatment Permit Application M-5 | 412 |
Medical Waste Storage Permit Application | 413 |
UST 30 Day Statistical Inventory Reconciliation (SIR) Log M-3 | 414 |
UST Notice of Intent to Permanently Close Underground Storage Tanks or Piping M-4 | 422 |
UST Notice of Proposed UST New Installation or Modification M-5 | 423 |
Notification of Election of Coverage under The Alabama Drycleaning Environmental Response Trust Fund Act M-3 | 425 |
Permit Application Solid Waste Disposal Facility M-2 | 439 |
UST Statistical Inventory Reconciliation SIR 7 Day Release Investigation Report M-3 | 460 |
UST Tank Trust Fund Eligibility/Ineligibility Determination Form M-1 | 462 |
UST Underground and Above Ground Storage Tank Transfer of Ownership M-3 | 469 |
UST ARBCA Tier 1 Report Forms | 471 |
UST ARBCA Tier 2 Report Forms | 472 |
UST ARBCA Tier 3 Report Forms | 473 |
UST Closure Site Assessment Report Form M-4 | 474 |
UST Free Product Recovery Report Form | 475 |
UST Groundwater Monitoring Report Form M-1 | 476 |
UST Line Tightness Test Report Form M-3 | 477 |
UST Natural Attenuation Monitoring Report Form | 478 |
UST Release Fact Sheet | 479 |
UST Release Report Form M-3 | 480 |
UST Site Classification System Checklist | 481 |
UST System Effectiveness Monitoring Report Form | 482 |
UST Tracer Tank Tightness Test Report Form M-2 | 483 |
UST Ullage Tank Tightness Test Report Form M-2 | 484 |
UST Tank Tightness Test (Vacuum) Report M-3 | 485 |
UST Volumetric Overfill Tank Tightness Test Report Form M-2 | 486 |
UST Volumetric Underfill Tank Tightness Test Report Form M-1 | 487 |
UST Closure Total Potential VOC Emissions Calculations | 492 |
Voluntary Cleanup Program Application M-3 | 521 |
Technical Proposal for Qualification as a Large Site Scrap Tire Fund Remediation Center M-1 | 530 |
Scrap Tire Manifest M-4 | 536 |
Scrap Tire Registration & Exemption Application M-7 | 537 |
Scrap Tire Transporter Permit Application M-8 | 538 |
Scrap Tire Quarterly Report M-6 | 539 |
Scrap Tire Processor Permit Application M-7 | 540 |
Scrap Tire Site Registration M-1 | 541 |
Brownfields State Revolving Fund Pre-Application Form M-1 | 542 |
Brownfields State Revolving Fund Application Form M-1 | 543 |
Cathodic Protection Monitoring for Galvanic Systems M-2 | 545 |
Alabama Hazardous Waste Receipt for Samples and Documents | 546 |
Brownfields Assessment Request Application M-1 | 550 |
UST Line Leak Detector (LLD) Test Report M-3 | 551 |
UST 3 Year Containment Sump Integrity Test Report (Low Level Method) M-1 | 556 |
UST 3 Year Containment Sump Integrity Test Report M-1 | 557 |
UST 30 Day Walkthrough Inspection Checklist Log M-2 | 558 |
UST 3 Year Overfill Prevention Equipment Inspection Report M-2 | 559 |
UST Annual Probe and Sensor Test Report M-1 | 560 |
UST Annual Release Detection Equipment Operation and Calibration Testing Log M-2 | 561 |
UST Compatibility Demonstration Log M-1 | 562 |
UST Manual Tank Gauging Monthly Log M-1 | 563 |
UST Annual Liquid Sensor Inspection and Functionality Test M-1 | 564 |
UST Annual Tank Gauge Test Report M-1 | 565 |
UST Automatic Line Leak Detector (ALLD) and Line Tightness Test Report M-1 | 566 |
Application for Facility Name Change or Transfer of Solid Waste Disposal Facility Permit | 568 |
Beneficial Use Facility Registration Application M-1 | 569 |
Beneficial Use Annual Reporting M-1 | 571 |
Notification of Regulated Waste Activity M-7 | 8700-12 |
Water Program | |
Drinking Water - Groundwater System Monthly Operational Data Report M-1 | 8 |
Information Needed for 316(b) Determination in Regard to General NPDES Permits | 14 |
Notice of Termination NPDES General Permit Number ALR100000 M-2 | 21 |
NPDES Construction Stormwater Inspection Report and BMP Certification M-1 | 23 |
Notice of Intent NPDES General Permit Number ALR100000 (Construction Stormwater) M-3 | 24 |
NPDES Construction Stormwater Noncompliance Notification M-1 | 25 |
Notice of Intent-NPDES General Permit Number ALG850000 M-4 | 26 |
Drinking Water - Operational Evaluation Level Exceedance Report M-2 | 27 |
Notice of Intent-General Permit Number ALG870000 (Pesticides) M-2 | 28 |
ADEM NPDES Pesticide Adverse Incident Report M-1 | 29 |
Notice of Termination - NPDES General Permit Number ALG870000 M-1 | 30 |
EDWRS Permittee Registration Form | 33 |
EDWRS Lab Registration Form | 34 |
EDWRS Terms and Conditions Agreement | 35 |
Drinking Water - Total Coliform Rule - Level 1 Assessment M-2 | 36 |
Drinking Water - Total Coliform Rule - Level 2 Assessment M-2 | 37 |
Drinking Water- Certification of Well Completion | 59 |
Drinking Water - Notification of Intent to Drill a Water Well | 60 |
Drinking Water - Purchase Water System Monthly Operation Report M-1 | 185 |
State Indirect Discharge (SID) Permit Application M-6 | 186 |
NPDES Individual Permit Application Supplementary Information for Industrial Facilities M-7 | 187 |
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 M-4 | 188 |
Permit Application of Reclaimed Water Reuse (RWR) | 189 |
Application for Alabama Well Driller's License M-1 | 193 |
Water Well Driller Reciprocal Application | 194 |
Water Well Standards Program License Renewal | 195 |
Drinking Water - Filter Plant Monthly Operational Data Report M-1 | 242 |
Drinking Water - Monthly Membrane Surface Plant Operational Data Report M-1 | 243 |
Drinking Water - Application for Approval to Use a Water Supply Well | 259 |
Alternative Analysis | 311 |
Calculation of Total Annualized Project Cost for PublicSector Projects | 312 |
Calculation of Total Annualized Project Cost for Private-Sector Projects | 313 |
ADEM Baseline Monitoring Report Submittal Form | 314 |
NPDES Individual Permit Application (Mining Operations) M-6 | 315 |
Annual Certification Form for Discharges Associated with Petroleum Storage and Handling Areas M-2 | 324 |
Drinking Water - Chemical Monitoring Data Report M-1 | 335 |
Drinking Water - Chemical Monitoring Waiver Application M-1 | 336 |
Clean Water State Revolving Fund (CWSRF) Loan Application Form M-3 | 339 |
Clean Water State Revolving Fund (CWSRF) Preapplication Form M-4 | 340 |
Coalbed Methane Stormwater Inspection Summary Report M-1 | 343 |
Coalbed Methane Temporary Pit Wastewater Land Application Certification Report M-1 | 344 |
Drinking Water - Community Public Notification Certification Form | 345 |
Drinking Water - Community System Susceptibility Analysis Sheet M-1 | 346 |
Drinking Water - Consumer Confidence Report (CCR) Certification Form M-2 | 347 |
Drinking Water State Revolving Fund (DWSRF) Loan Application Form M-3 | 369 |
Drinking Water State Revolving Fund (DWSRF) Preapplication Form M-4 | 370 |
NPDES Individual Permit Application Addendum M-1 | 376 |
NPDES Individual Permit Application Minor Permit Modification Addendum M-2 | 377 |
Notice of Intent-NPDES General Permit Number ALG110000 M-5 | 380 |
Notice of Intent-NPDES General Permit Number ALG120000 M-6 | 381 |
Notice of Intent-NPDES General Permit Number ALG140000 M-5 | 382 |
Notice of Intent-NPDES General Permit Number ALG150000 M-4 | 383 |
Notice of Intent-NPDES General Permit Number ALG160000 M-4 | 384 |
Notice of Intent-NPDES General Permit Number ALG170000 M-4 | 385 |
Notice of Intent-NPDES General Permit Number ALG180000 M-4 | 386 |
Notice of Intent-NPDES General Permit Number ALG020000 M-4 | 387 |
Notice of Intent-NPDES General Permit Number ALG200000 M-4 | 388 |
Notice of Intent-NPDES General Permit Number ALG230000 M-4 | 389 |
Notice of Intent-NPDES General Permit Number ALG240000 M-4 | 390 |
Notice of Intent-NPDES General Permit Number ALG250000 M-5 | 391 |
Notice of Intent-NPDES General Permit Number ALG280000 M-5 | 392 |
Notice of Intent-NPDES General Permit Number ALG030000 M-4 | 393 |
Notice of Intent-NPDES General Permit Number ALG340000 M-5 | 394 |
Notice of Intent-NPDES General Permit Number ALG360000 M-6 | 395 |
Notice of Intent-NPDES General Permit Number ALG060000 M-5 | 396 |
Notice of Intent-NPDES General Permit Number ALG670000 M-4 | 397 |
Drinking Water - Lead and Copper Monitoring Data Report M-1 | 405 |
Material Safety Data Sheet Reporting | 407 |
Drinking Water - Maximum Residual Disinfectant Level Input Form (Samples) M-1 | 408 |
Sanitary Sewer Overflow (SSO) Event Reporting Form M-4 | 415 |
Municipal Water Pollution Prevention (MWPP) Annual Report (Collection Systems) Package M-1 | 416 |
Municipal Water Pollution Prevention (MWPP) Annual Report Package M-3 | 417 |
Municipal Water Pollution Prevention Resolution Form | 418 |
MWPP Sewage Sludge Survey M-1 | 419 |
Drinking Water - Non-Community Public Notification Certification Form | 420 |
NPDES/SID Non-Compliance Notification Form M-4 | 421 |
NPDES Annual Notice of Registration (NOR) | 429 |
NPDES Individual Permit Pollution Abatement/Treatment Measures and Sediment Control Structures Certification Report M-2 | 432 |
NPDES Permitted Coalbed Methane Operations Pollution Abatement/Treatment Measures and Waste Treatment Facilities Certification Report M-1 | 433 |
Operator Certification Renewal Form M-1 | 435 |
Plant and Collection System Personnel Inventory | 441 |
Drinking Water - Potable Water Laboratory Certification Application M-3 | 442 |
Drinking Water - Progress Report Form M-1 | 443 |
Drinking Water - Project Completion Form M-2 | 444 |
Release Information Form | 447 |
Representative Stormwater Outfall Certification M-3 | 450 |
Request for NPDES Permit Post-Mining Discharge Limitations (Coal Mining Operations) M-2 | 451 |
Request for Release from NPDES Permit Monitoring and Reporting Requirements (Mining Operations) M-3 | 452 |
Request to Remove Subsurface Withdrawal from Discharge Structure (NPDES-Permitted Mining Operations) M-2 | 453 |
Request to Remove Treatment Basin/Pond or Other Discharge Structure (NPDES-Permitted Mining Operations) M-3 | 454 |
Required Information for Mixing Zone Modeling M-1 | 455 |
SID Discharge Monitoring Report Form (Monthly) | 457 |
SID Discharge Monitoring Report Form (Quarterly) | 458 |
SRF Payment Request Form | 459 |
Drinking Water - Surface Source Susceptibility Analysis Worksheet M-1 | 461 |
Toxicity Discharge Monitoring Report Form | 464 |
Toxicity Test Report Summary | 465 |
NPDES/SID/UIC Permit Transfer Agreement M-3 | 466 |
Drinking Water - Construction Permit Application M-2 | 488 |
Drinking Water - Modification Permit Application | 489 |
Drinking Water - Renewal Permit Application M-2 | 490 |
Drinking Water - Public Water System Information Update M-1 | 491 |
Notice of Intent-NPDES General Permit Number ALG890000 M-6 | 498 |
Notice of Termination - NPDES General Permit Number ALG890000 M-4 | 499 |
NPDES Noncoal/Nonmetallic Mining and Dry Processing Less than Five Acres Stormwater Inspection Report and BMP Certification M-3 | 500 |
NPDES Small Mining Noncompliance Notification Report M-4 | 501 |
Notice of Intent - NPDES General Permit Number ALR040000 (MS4 Phase II) M-3 | 503 |
Water and Wastewater Operator Exam Application M-1 | 505 |
Water and Wastewater Operator Experience Verification M-1 | 506 |
Water and Wastewater Reciprocal Application M-1 | 507 |
Water and Wastewater Operator for Multiple Systems M-1 | 508 |
Cooling Water Supplemental Information M-2 | 510 |
EDMR Daily Discharge Monitoring Report Form | 514 |
EDMR Monthly Discharge Monitoring Report Form | 515 |
Supplemental Petroleum Application Information | 516 |
Alabama Clean Vessel Act Grant Application | 517 |
Boating Infrastructure Grant Application | 518 |
General Phase II MS4 Stormwater Permit Renewal Notice of Intent M-1 | 520 |
Notice of Intent-NPDES General Permit Number ALG640000 M-6 | 522 |
Hydrogeology Unit Evaluation Report Form | 531 |
Documentation of Disability Related Needs | 533 |
Drinking Water - Giardia and Virus Profile Spreadsheet M-1 | 535 |
Drinking Water - WTP Quarterly Report for the Disinfectants and Disinfection Byproducts Rule M-2 | 547 |
NPDES Individual Permit Application (Coalbed Methane Operations) M-4 | 549 |
Notice of Intent-UIC General Permit Number ALIG010000 | 552 |
Notice of Intent-UIC General Permit Number ALIG020000 | 553 |
Notice of Termination - NPDES General Permits (Industrial Activities) | 554 |
No Exposure Certification for Exclusion from NPDES Stormwater Permitting for Industrial Activities M-1 | 555 |
NPDES Mining and Preparation Plant Outfall Data for Metals, Cyanide, and Total Phenols | 567 |
One-Time Compliance Report for Dental Dischargers | 570 |
Ala. Admin. Code r. 335-1-1-.07
Forms are available on the ADEM website at www.adem.alabama.gov.
Appendix A, Forms can no longer be found at the end of the Chapter 335-1-1. It will be placed at the end of all chapters in Division 335-1.
Author: Marilyn Elliott, Russell A. Kelly, Aubrey White, David Hutchinson, Brian C. Espy
Statutory Authority:Code of Ala. 1975, §§22-22A-5, 22-22A-6, 22-22A-8, 411-22-4, 41-22-5.