Home Alabama Department of Environmental Management
Skip Navigation LinksHome > ADEM Programs > Water > Water Forms
Lower High Falls, Talladega Forest - Bill Wilson
Water Division Forms

These files are optimized for viewing in Adobe Reader 9. Download it for free here.

Industrial Permit Application Checklist
Process Water
Non-Process Water
Multi-Category Water
Storm Water

EPA Forms
Form 1 - General Information Form
Used in conjunction with ADEM Form 187, EPA Form 1, 2C, 2D, 2E, 2F

EPA Forms
Form 2A - Application Overview
Used for application to discharge municipal wastewater from new and existing publicly owned treatment works

Form 2C - Wastewater Discharge Information
Used for renewal of processed wastewater NPDES industrial permits and must be accompanied by ADEM Form 187 and EPA Form 1

Form 2D - New Sources & New Discharges
Used for initial applications of NPDES industrial permits and must be accompanied by ADEM Form 187 and EPA Form 1

Form 2E - Facilities Which Do Not Discharge Process Wastewater
Used for facilities which do not process wastewater. This form is generally used for non-contact water. ADEM Form 187 and EPA Form 1 must accompany this form

Form 2F - Application for Permit to Discharge Storm Water Associated with Industrial Activity
Used for all discharges of storm water associated with an industrial activity. Facilities whose discharges are composed of storm water and non-storm water must submit the appropriate non-storm water form and Form 2F for their storm water. ADEM Form 187 and EPA Form 1 must accompany this form

Form 2S - Permit Application Information for Sewage Sludge Use or Disposal Information
Used to provide sewage sludge use or disposal information (Only Part 2 is required). ADEM Form 188 and EPA Forms 1 and 2A must accompany this form.

Form 3510-11 - No Exposure Certification for Exclusion from NPDES Stormwater Permitting
Used to give notice that a facility does not require permit authorization for its stormwater discharges associated with industrial activity due to the existence of a condition of no exposure.
Please be aware the No Exposure Certification, if applicable, should be submitted to:
Industrial General Permit Section
Industrial/Municipal Branch
Water Division
Alabama Department of Environmental Management
PO Box 301463
Montgomery, AL 36130-1463


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
020 Spill Catchment Basin/Spill Bucket 3 Year Test Log
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
031 Alabama Tank Trust Fund Cost Proposal Part 1
032 Alabama Tank Trust Fund Payment Request
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
279 Notification for Underground Storage Tanks
283 Notification for Above Ground Storage Tanks
310 Notice of Temporary Closure
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
326 Annual Statistical Inventory Reconciliation (SIR) Report Form
332 Cathodic Protection Monitoring Form for Impressed Current Systems
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
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
400 Impressed Current Cathodic Protection System 60-Day Inspection Log
403 Interior Lining Inspection Form
404 Interior Lining Report Form
405 Drinking Water - Lead and Copper Monitoring Data Report
406 Manual Interstitial Monitoring Monthly Log
407 Material Safety Data Sheet Reporting
408 Drinking Water - Maximum Residual Disinfectant Level Input Form (Samples)
409 Maximum Residual Disinfectant Level Input Form (Sources)
414 Monthly Statistical Inventory Reconciliation (SIR) Report
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
422 Notice of Intent to Permanently Close Underground Storage Tanks
423 Notice of Proposed UST New Installation or Upgrade
424 Notification - Above the Threshold Planning Quantities (TPQ) of Extremely Hazardous Substances
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
460 Statistical Inventory Reconciliation SIR 7 Day Release Investigation Notice Form
461 Drinking Water - Surface Source Susceptibility Analysis Worksheet
462 Tank Trust Fund Eligibility/Ineligibility Determination Form
464 Toxicity Discharge Monitoring Report Form
465 Toxicity Test Report Summary
466 NPDES/SID Permit Transfer Agreement
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
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
492 UST Closure Total Potential Voc Emissions Calculations
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
511 Permittee Registration Form for e-DMR/e-SSO
512 Electronic Registration Form (ESA) for e-DMR and e-SSO
513 Deactivation Request Form for e-DMR/e-SSO
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
534 EHS Notification Form
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
551 ADEM Line Leak Detector (LLD) Test Report Form
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
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