Division Forms and Information
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Form Description |
Number |
Form |
Instructions |
PRE-INSTALLATION NOTIFICATION FORM |
CN-1288 |
Payment of fees
must accompany this form. |
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NOTIFICATION FOR UNDERGROUND STORAGE TANKS |
CN-1260 |
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. |
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AMENDED NOTIFICATION FOR UNDERGROUND STORAGE TANKS SELLER REPORTING CHANGE OF OWNERSHIP OF TANKS
|
CN-0911 |
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. |
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NOTIFICATION OF INDICIA OF OWNERSHIP |
CN-1186 |
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 |
Voluntary Registry sign up information. |
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E-85 INFORMATION INSTRUCTIONS |
LINK | Information on ethanol blended fuels and forms. |
Form Description |
Number |
Form |
Instructions |
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CLOSURE PACKET
You will need these resources if you close your tanks.
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CLOSURE PACKET INSTRUCTIONS |
Revised July 2005
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Instruction for Closure Packet. | |
UST SYSTEM CLOSURE ASSESSMENT GUIDELINES |
Revised Sept. 2006 |
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) |
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APPLICATION FOR PERMANENT CLOSURE OF UNDERGROUND STORAGE TANKS |
CN-0928 (Rev. 7/05) |
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PERMANENT CLOSURE REPORT |
CN-0927 (Rev. 4/07) |
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APPLICATION TO TREAT PETROLEUM CONTAMINATED SOIL BY MOBILE THERMAL TREATMENT |
July 1,2005
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APPLICATION TO TREAT PETROLEUM CONTAMINATED SOIL BY AERATION |
July 1, 2005 |
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APPROVED METHODS FOR ANALYSIS OF SOIL AND WATER SAMPLES |
LINK | |||
FIELD OFFICE LOCATION MAP |
LINK | |||
APPROVED CORRECTIVE ACTION CONTRACTOR LIST |
March 9, 2011 |
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TGD-005 SAMPLING REQUIREMENTS FOR EXCAVATED MATERIAL |
TGD-005 (Rev. 7/1/05) |
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TGD-009 REQUIREMENTS TO TREAT PETROLEUM CONTAMINATED SOIL GENERATED FROM RELEASES FROM UNDERGROUND STORAGE TANKS |
TGD-009 (Rev. 7/1/05) |
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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) |
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Reference 1 |
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Reference 2 |
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Form Description |
Number |
Form |
Instructions |
COMPLIANCE TOOL BOX |
LINK | Latest edition of Compliance Tool Box | |
UST OWNER COMPLIANCE MANUAL |
LINK | ||
IMPRESSED CURRENT CATHODIC PROTECTION RECTIFIER READING FORM |
CN-1282 |
60-Day Log for Impressed Current Systems | |
IMPRESSED CURRENT CATHODIC PROTECTION TESTING SURVEY |
CN-1309 |
3-Year Impressed Current Cathodic Protection Test This form can be filled out using your computer or printed |
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GALVANIC CATHODIC PROTECTION TESTING SURVEY |
CN-1140 |
3-Year Galvanic Cathodic Protection Test This form can be filled out using your computer or printed |
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ANNUAL ELECTRONIC INTERSTITIAL MONITORING TEST REPORT |
CN-1339 |
This form can be filled out using your computer or printed. | |
MONTHLY ELECTRONIC INTERSTIAL MONITORING REPORT |
CN1340 |
This form can be filled out using your computer or printed. | |
MONTHLY SPILL BUCKET INSPECTION LOG |
CN-1286 |
This form can be filled out using your computer or printed. | |
QUARTERLY DISPENSER INSPECTION LOG |
CN-1287 |
This form can be filled out using your computer or printed. | |
PREPARING FOR A COMPLIANCE INSPECTION |
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ETHANOL EQUIPMENT COMPATIBILITY CHECKLIST |
CN-1285 (Rev. 7/10) |
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STATEMENT OF COMPATIBILITY |
CN-1283 |
This form is used for indicating that the UST system components will be compatible with the product stored. | |
COMPLIANCE GUIDANCE DOCUMENTS (CGD'S) |
LINK | These documents provide additional guidance for the Underground Storage Tank Rules. |
Form Description |
Number |
Form |
Instructions |
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REIMBURSEMENT GUIDANCE DOCUMENTS |
RGD-002 (Rev. 1/2/12) |
DOC | ||||
TASK COST SHEETS |
RGD-002 |
EXCEL | ||||
APPLICATION FOR FUND ELIGIBILITY |
CN-0943 (Rev. 6/08) |
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 a release is suspected, even if all the confirmation steps have not been taken. |
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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. |
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| CORRECTIVE ACTION CONTRACTOR INFORMATION | Approved Corrective Action Contractor List |
Rev. 2/7/12 |
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Application for Approved Corrective Action Contractor Status |
CN-0945 (Rev. 1/08) |
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| GUIDELINES, FORMS, AND TECHNICAL GUIDANCE DOCUMENTS
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Environmental Assessment Guidelines |
Sept. 2006 |
Note corrected benzene number for indoor inhalation for commercial worker Reference 3 effective April 1, 2007 | |||
Site Check Report Guidelines |
Aug. 1996 |
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Initial Site Characterization Guidelines - Parts A and B |
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Initial Response and Hazard Management Report Guidelines - Part A |
Sept. 2006 |
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Initial Site Characterization Report Guidelines |
Sept. 2006 |
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Environmental Assessment Report Guidelines |
Aug. 1996 |
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Corrective Action Plan Guidelines |
Jan. 2010 |
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| Corrective Action System Figures - 2010 | TDEC Air Lift CAS Figure Package |
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TDEC Groundwater Pump CAS Figure Package |
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TDEC Standard CAS Figure Package |
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Cost Proposal, Phase I, CAP Implementation |
CN-1234 |
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Cost Proposal, Phase II, CAP Implementation |
CN-1235 |
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Corrective Action System Field Log |
Excel | |||||
Hazard Notification Report Form |
CN-1259 |
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Reference 1 |
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Reference 2 |
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Technical Guidance Documents (TGDs) |
LINK | |||||
Form Description |
Number |
Form |
Instructions |
APPROVED CORRECTIVE ACTION CONTRACTOR LIST |
February 7, 2012 |
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APPROVED STATISTICAL INVENTORY RECONCILIATION (SIR) VENDORS |
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TANK TIGHTNESS TESTERS |
Updated April 2004 |
LINK |
On May 1, 2011, new mileage and lodging rates for reimbursement go into effect.