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Underground Storage Tanks Forms

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NOTIFICATION

Form Description

Number

Form

Instructions

PRE-INSTALLATION
NOTIFICATION FORM
CN-1288 PDF

Payment of fees must accompany this form.

NOTIFICATION
FOR
UNDERGROUND STORAGE TANKS

CN-1260 PDF

Register unregistered tanks, closures, upgrades, new installations, new ownership and name or mailing address changes.

A change in tank status such as from "currently in use" to "temporarily out of use" must also be reported on this form.

The law requires that changes be reported within thirty (30) days.

CHANGE OF OWNER MAILING ADDRESS

AMENDED NOTIFICATION

CN-1383 PDF

This Form is a simple one page form that can be used to change the mailing address of the owner.

AMENDED NOTIFICATION FOR UNDERGROUND STORAGE TANKS

SELLER REPORTING CHANGE OF OWNERSHIP OF TANKS

 

CN-0911 PDF

A registered owner who has just sold tanks is also required to report that change within thirty (30) days.

This one-page form should be completed by the seller.

Note that this form includes a place for the seller to report how the buyer was informed of notification requirements by the seller.

Informing the buyer is also required by law.

BUYER'S NOTIFICATION

CN-1392 PDF  

NOTIFICATION OF INDICIA OF OWNERSHIP

CN-1186 PDF

A lender or lending institution who has acquired tanks through foreclosure or other acquistion and who has no intention to operate the tank must report the acquisition of tanks on this one page form.

VOLUNTARY REGISTRY FORM & INSTRUCTIONS

CN-1267 PDF

Voluntary Registry sign up information.

E-85 INFORMATION INSTRUCTIONS

  LINK

Information on ethanol blended fuels and forms.

 

TANK CLOSURE

Form Description

Number

Form

Instructions

CLOSURE
PACKET

 

You will need these resources if you close your tanks.

 

CLOSURE PACKET INSTRUCTIONS

Revised July 2005 PDF

Instruction for Closure Packet.

UST SYSTEM CLOSURE ASSESSMENT GUIDELINES

Revised Sept. 2006 PDF

When closing your tanks, complete the "Closure Application".

Submit the application to the appropriate Field Office for approval 30 days prior to closing the UST system.

After tanks are out of the ground or properly closed in place, be sure to file an amended notification form with TN UST.

This stops the automatic billing procedure for annual tank registration.

(Note Corrected values on Table 5 effective April 1, 2007)

APPLICATION FOR PERMANENT CLOSURE OF UNDERGROUND STORAGE TANKS

CN-0928
(Rev. 7/05)
PDF  

PERMANENT CLOSURE REPORT

CN-0927
(Rev. 4/07)
PDF  

APPLICATION TO TREAT PETROLEUM CONTAMINATED SOIL BY MOBILE THERMAL TREATMENT

July 1, 2005

 


PDF  

APPLICATION TO TREAT PETROLEUM CONTAMINATED SOIL BY AERATION

July 1, 2005 PDF  

APPROVED METHODS FOR ANALYSIS OF SOIL AND WATER SAMPLES

  LINK  

FIELD OFFICE LOCATION MAP

  LINK  

APPROVED CORRECTIVE ACTION CONTRACTOR LIST

July 8, 2013 PDF  

TGD-005 SAMPLING REQUIREMENTS FOR EXCAVATED MATERIAL

TGD-005
(Rev. 7/1/05)
PDF  

TGD-009 REQUIREMENTS TO TREAT PETROLEUM CONTAMINATED SOIL GENERATED FROM RELEASES FROM UNDERGROUND STORAGE TANKS

TGD-009
(Rev. 7/1/05)
PDF  

TGD-011 PROCEDURES TO DETERMINE THE APPLICABLE SOIL AND GROUND WATER CLEANUP LEVELS DURING AN UNDERGROUND STORAGE TANK SYSTEM CLOSURE

TGD-011
(RESCINDED July 1, 2005)
PDF  
Reference 1 PDF  
Reference 2 PDF  

 

OPERATIONAL COMPLIANCE

Form Description

Number

Form

Instructions

COMPLIANCE TOOL BOX

  LINK

Latest edition of Compliance Tool Box

UST OWNER COMPLIANCE MANUAL

  LINK  

PRECISION LINE TIGHTNESS AND LEAK DETECTOR TEST REPORT

CN-1341 PDF

Line Tightness & Leak Detector Test that can be used for release detection, repair, release investigation, or new installation.

IMPRESSED CURRENT CATHODIC PROTECTION RECTIFIER READING FORM

CN-1282 PDF

60-Day Log for Impressed Current Systems

IMPRESSED CURRENT CATHODIC PROTECTION TESTING SURVEY

CN-1309 PDF

3-Year Impressed Current Cathodic Protection Test

GALVANIC CATHODIC PROTECTION TESTING SURVEY

CN-1140 PDF

3-Year Galvanic Cathodic Protection Test

MONTHLY SPILL BUCKET INSPECTION LOG

CN-1286 PDF  
SPILL PREVENTION DEVICE HYDROSTATIC TEST REPORT CN-1366 PDF

This form can be used to record hydrostatic testing of spill buckets.

QUARTERLY DISPENSER INSPECTION LOG

CN-1287 PDF  

MONTHLY ELECTRONIC INTERSTITIAL MONITORING REPORT

CN-1340 PDF

This form is used for Interstitial Monitoring release detection.

ANNUAL ELECTRONIC INTERSTITIAL MONITORING TEST REPORT

CN-1339 PDF  
MANUAL TANK GAUGING MONTHLY REPORT CN-1367 PDF

This form can be used to record monthly Manual Tank Gauging Reports.

PREPARING FOR A COMPLIANCE INSPECTION

  PDF  

ETHANOL EQUIPMENT COMPATIBILITY CHECKLIST

CN-1285
(Rev. 7/10)
PDF  

STATEMENT OF COMPATIBILITY

CN-1283 PDF

This form is used for indicating that the UST system components will be compatible with the product stored.

VISUAL INSPECTION FOR INCOMPATIBLE DISPENSER COMPONENTS CN-1284 PDF

This form is used for recording daily visual inspections of incompatible dispenser components.

COMPLIANCE GUIDANCE DOCUMENTS (CGD'S)

  LINK

These documents provide additional guidance for the Underground Storage Tank Rules.

 

RELEASE, FUND, AND REIMBURSEMENT

Form Description

Number

Form

Instructions

REIMBURSEMENT GUIDANCE DOCUMENTS

RGD-002
(Rev. 1/10)
DOC PDF  

TASK COST SHEETS

RGD-002 EXCEL  
BLANK SIGNATURE PAGES FOR ELECTRONIC REIMBURSEMENT APPLICATIONS CN-0923 PDF See Reimbursement Guidance Documents

APPLICATION FOR FUND ELIGIBILITY

CN-0943
(Rev. 6/08)
PDF

Application for Fund Eligibility Deadline –

The UST Act establishes a deadline for tank owners, tank operators or petroleum site owners to file an Application for Fund Eligibility.

If the application form is not received by the UST Division by the deadline established by law, the release WILL NOT BE FUND ELIGIBLE. The application must be received:

Within 60 days of a release which was identified in any manner other than the process for confirmation of a suspected release in the regulations;

or

Within 90 days of the discovery of evidence of a suspected release which is subsequently confirmed in accordance with the regulatory requirements.

NOTE: The 90 day deadline applies even if confirmation of a release does not occur within 90 days of the discovery of evidence of a suspected release.

An application should be filed as soon as possible after arelease is suspected, even if all the confirmation steps have not beentaken.

REIMBURSEMENT RATES

 

  LINK

Please use the new Reimbursement Guidance Document, which includes the Fund Eligibility Application, eligible and ineligible costs, and the new Reimbursement Application form.

CORRECTIVE ACTION CONTRACTOR INFORMATION

Approved Corrective Action Contractor List

Rev. 7/8/13 PDF  

Application for Approved Corrective Action Contractor Status

CN-0945
(Rev. 12/12)
PDF  

GUIDELINES, FORMS, AND TECHNICAL GUIDANCE DOCUMENTS

Environmental Assessment Guidelines

Sept. 2006 PDF

Note corrected benzene number for indoor inhalation for commercial worker Reference 3 effective April 1, 2007

Site Check Report Guidelines

Aug. 1996 PDF  

Initial Site Characterization Guidelines - Parts A and B

  PDF  

Initial Response and Hazard Management Report Guidelines - Part A

Sept. 2006 PDF  

Initial Site Characterization Report Guidelines

Sept. 2006 PDF  

Environmental Assessment Report Guidelines

Aug. 1996 PDF  

Corrective Action Plan Guidelines

Jan. 2010 PDF  

Corrective Action System Figures - 2010

TDEC Air Lift CAS Figure Package

   PDF  

TDEC Groundwater Pump CAS Figure Package

  PDF  

TDEC Standard CAS Figure Package

  PDF  

Corrective Action System Field Log

  Excel  

Hazard Notification Report Form

CN-1259 PDF  

Reference 1

  PDF  

Reference 2

  PDF  

Technical Guidance Documents (TGDs)

  LINK  

 

WHO TO CALL: CONTRACTORS, VENDORS, AND TESTERS

Form Description

Number

Form

APPROVED CORRECTIVE ACTION CONTRACTOR LIST February 7, 2012 PDF
APPROVED STATISTICAL INVENTORY RECONCILIATION (SIR) VENDORS August 27, 2012 PDF
TANK TIGHTNESS TESTERS Updated April 2004 LINK

New Mileage and Lodging Rates Effective October 1, 2008

On October 1, 2008 new mileage and lodging rates for reimbursement go into effect.

Schedule of New Rates