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Division of Underground Storage Tanks

Division Forms and Information 

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Notification                 

Operational Compliance

Tank Closure             

Release, Fund, & Reimbursement

Who to call: Contractors, Vendors, and Testers

 

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.

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.

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
March 9, 2011
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  
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

This form can be filled out using your computer or printed

GALVANIC CATHODIC PROTECTION TESTING SURVEY
CN-1140
PDF

3-Year Galvanic Cathodic Protection Test

This form can be filled out using your computer or printed

ANNUAL ELECTRONIC INTERSTITIAL MONITORING TEST REPORT
CN-1339
PDF This form can be filled out using your computer or printed.
MONTHLY ELECTRONIC INTERSTIAL MONITORING REPORT
CN1340
PDF This form can be filled out using your computer or printed.
MONTHLY SPILL BUCKET INSPECTION LOG
CN-1286
PDF This form can be filled out using your computer or printed.
QUARTERLY DISPENSER INSPECTION LOG
CN-1287
PDF This form can be filled out using your computer or printed.
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.

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. 1/2/12)
DOC PDF  
TASK COST SHEETS
RGD-002
EXCEL  
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 a release is suspected, even if all the confirmation steps have not been taken.

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. 2/7/12
PDF  
Application for Approved Corrective Action Contractor Status
CN-0945 (Rev. 1/08)
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  
Cost Proposal, Phase I, CAP Implementation
CN-1234
PDF  
Cost Proposal, Phase II, CAP Implementation
CN-1235
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

Instructions

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

  

New Mileage and Lodging Rates Effective May 1, 2011

On May 1, 2011, new mileage and lodging rates for reimbursement go into effect.

Schedule of New Rates