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Lower High Falls, Talladega Forest - Bill Wilson
ADEM Departmental Forms

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

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
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
570L 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
481 UST Site Classification System Checklist
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