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

ADEM Departmental Forms



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

Form # Form Name Program
008 Groundwater System Monthly Operational Data Report Water
009 Alabama Recycling Fund Grant Application Waste/Remediation
011 Solid Waste Landfill Operator Initial Certification Application Waste/Remediation
012 Solid Waste Landfill Operator Reciprocal Certification Application Waste/Remediation
013 Solid Waste Landfill Operator Certification Renewal Waste/Remediation
014 Information Needed for 316(b) Determination in Regards to General NPDES Permits Water
015 Processing and Recycling General Information Waste/Remediation
016 Annual Recycling Report (for use by State Agencies/Departments and Schools ONLY) Waste/Remediation
017 Specifications for Air Curtain Incinerators Air
018 Composting Facility Application Waste/Remediation
019 Annual Containment Sump Inspection Log Waste/Remediation
021 Termination Request - General Permit Number ALR100000 Water
022 NPDES General Permit ALR100000 Water
023 NPDES Construction Stormwater Inspection Report and BMP Certification Water
024 Notice of Intent - General Permit Number ALR100000 Water
025 NPDES Construction Stormwater Noncompliance Notification Report Water
026 Notice of Intent - General Permit Number ALG850000 Water
027 Operational Evaluation Level Exceedance Report Water
028 Notice of Intent - General Permit Number ALG870000 Water
029 NPDES Pesticide Adverse Incident Report Form Water
030 Notice of Termination - General Permit Number ALG870000 Water
052 Registration Form for the Construction, Installation, or Modification of an Incinerator Air
060 Notification of Intent to Drill a Water Well Water
103 Operating Permit Application Facility Identification Form Air
104 Permit Application for Indirect Heating Equipment Air
105 Permit Application for Manufacturing or Processing Operation Air
106 Permit Application for Waste Disposal Air
107 Permit Application for Stationary Internal Combustion Engines Air
108 Permit Application for Loading and Storage of Organic Compounds Air
109 Permit Application for Volatile Organic Compound Surface Coating Emission Source Air
110 Permit Application for Air Pollution Control Device Air
112 Permit Application for Solvent Metal Cleaning Air
166 Joint Application and Notification U.S. Department of Army, Corps of Engineers Alabama Department of Environmental Management Coastal
184 Seal Gap Test Form Air
185 Purchase Water System Monthly Operation Report Water
186 State Indirect Permit Application Water
187 NPDES Permit Application Supplementary Information Water
188 NPDES Permit Application Semi-Public and Private Facilities Water
193 Application For Alabama Well Driller's License Water
194 Water Well Driller Reciprocal Application Water
195 Water Well Standards Program License Renewal Water
197 Air Permit Application for Gasoline Dispensing Facilities Air
198 Gasoline Transport Tank Truck Application Air
242 Filter Plant Monthly Operational Data Report Water
243 Monthly Membrane Surface Plant Operational Data Report Water
259 Application for Approval to Use a Water Supply Well Water
278 Disposal Approval Request Waste/Remediation
279 Notification for Underground Storage Tanks Water
283 Notification for Above Ground Storage Tanks Water
300 Solid Waste Profile Sheet Waste/Remediation
302 Threshold Planning Quantities Waste/Remediation
305 Permit Application Solid Waste Disposal Facility Construction/Demolition Landfill Waste/Remediation
309 Cargo Tank Tightness Test Report Air
310 Notice of Temporary Closure Water
311 Alternative Analysis Water
312 Calculation of Total Annualized Project Cost for Public - Sector Projects Water
313 Calculation of Total Annualized Project Cost for Private - Sector Projects Water
314 ADEM Baseline Monitoring Report Submittal Form Water
315 ADEM Field Operation Division NPDES Individual Permit Application Water
316 Alabama Coastal Area Management Program Application for Approval of a Non-Regulated Use ADEM Adminstrative Code Rule 335-8-1-.11 Groundwater Extraction 50 GPM or Greater Coastal
317 Alabama Hazardous Waste/Used Oil Transporter Permit Application Waste/Remediation
318 Alabama Tank Trust Fund Cost Proposal Form Water
319 Alabama Tank Trust Fund Payment Request Form Water
323 Alternative Medical Waste Treatment Technology Equipment Approval Application Waste/Remediation
324 Annual Certification Form for Discharges Associated with Petroleum Storage and Handling Areas Water
326 Annual Statistical Inventory Reconciliation (SIR) Report Form Water
327 Application for a Permit for the Construction of a Motel, Hotel, or Other Multi-Unit Development on a Property Intersected by the Construction Control Line in the Alabama Coastal Area Coastal
328 Application for a Permit for the Construction of Single Family Dwellings, Duplexes, or Other Similar Structures on Properties Intersected by the Construction Control Line in the Alabama Coastal Area Coastal
329 Application for Approval of a Non-Regulated Use in the Alabama Coastal Area Developments and Subdivisions of Property Greater then 5 Acres in Size Coastal
330 Application for Name Change or Transfer of Permit Solid Waste Disposal Facility Waste/Remediation
331 Bulk (Gasoline) Plant Application Air
332 Cathodic Protection Monitoring Form for Impressed Current Systems Water
333 CBM NPDES Stormwater Discharge Monitoring Report Water
334 CBM Toxicity Test Report Summary Water
335 Chemical Monitoring Data Report Water
336 Chemical Monitoring Waiver Application Water
339 Clean Water State Revolving Fund (CWSRF) Loan Application Form Water
340 Clean Water State Revolving Fund (CWSRF) Preapplication Form Water
342 Coal Permit Precipitation Event Discharge Limitations Exemption Claim Report Water
343 Coalbed Methane Stormwater Inspection Summary Report Water
344 Coalbed Methane Temporary Pit Wastewater Land Application Certification Report Water
345 Community Public Notification Certification Form Water
346 Community System Susceptibility Analysis Sheet Water
347 Consumer Confidence Report Certification Form Water
348 Discharge Monitoring Report for CBM Coal - Type 60 Effluent Water
349 Discharge Monitoring Report for CBM Coal - Type 60 Manual Water
350 Discharge Monitoring Report for CBM Coal - Type 60 Standard Water
351 Discharge Monitoring Report for Coal - Type 1 & Type 3 Water
352 Discharge Monitoring Report for Coal - Type 11 Water
353 Discharge Monitoring Report for Coal - Type 13 Water
354 Discharge Monitoring Report for Coal - Type 14 Sand & Gravel Water
355 Discharge Monitoring Report for Coal - Type 14 Fire Clay Water
356 Discharge Monitoring Report for Coal - Type 14 Shale - Common Clay Water
357 Discharge Monitoring Report for Coal - Type 15 Water
358 Discharge Monitoring Report for Coal - Type 38 Water
359 Discharge Monitoring Report for Coal - Type 5 & Type 7 Water
360 Discharge Monitoring Report for Coal - Type 9 Water
361 Discharge Monitoring Report for NonCoal - Type 30 Water
362 Discharge Monitoring Report for NonCoal - Type 32 Water
363 Discharge Monitoring Report for NonCoal - Type 34 Water
364 Discharge Monitoring Report for NonCoal - Type 36 & Type 48 & Type 50 Water
365 Discharge Monitoring Report for NonCoal - Type 41 Water
366 Discharge Monitoring Report for NonCoal - Type 42 Water
367 Discharge Monitoring Report for NonCoal - Type 44 & Type 45 Water
368 Discharge Monitoring Report for NonCoal - Type 46 Water
369 Drinking Water State Revolving Fund (DWSRF) Loan Application Form Water
370 Drinking Water State Revolving Fund (DWSRF) Preapplication Form Water
372 Emissions Statement Reporting Form (For Shelby County Facilities Only) Air
373 Excess Emission Monitoring Report Air
374 Exemption Claim Form for Cofired Combustors (Appendix H - Division 3) Air
375 Exemption Claim Form For Incinerators Burning Only Pathological, Low-Level Radioactive, and Chemotherapeutic Waste (Appendix H - Division 3) Air
376 Field Operation Division NPDES Individual Permit Application Addendum Form Water
377 Field Operation Division NPDES Individual Permit Application Minor Permit Modification Addendum Form Water
378 Gasoline Dispensing Facility Information Survey Air
380 General Permit Application Package - NOI-11 Water
381 General Permit Application Package - NOI-12 Water
382 General Permit Application Package - NOI-14 Water
383 General Permit Application Package - NOI-15 Water
384 General Permit Application Package - NOI-16 Water
385 General Permit Application Package - NOI-17 Water
386 General Permit Application Package - NOI-18 Water
387 General Permit Application Package - NOI-2 Water
388 General Permit Application Package - NOI-20 Water
389 General Permit Application Package - NOI-23 Water
390 General Permit Application Package - NOI-24 Water
391 General Permit Application Package - NOI-25 Water
392 General Permit Application Package - NOI-28 Water
393 General Permit Application Package - NOI-3 Water
394 General Permit Application Package - NOI-34 Water
395 General Permit Application Package - NOI-36 Water
396 General Permit Application Package - NOI-6 Water
397 General Permit Application Package - NOI-67 Water
400 Impressed Current Cathodic Protection System 60-Day Inspection Log Water
401 Individual NPDES Permit Noncompliance Notification (5-day Report) Water
403 Interior Lining Inspection Form Water
404 Interior Lining Report Form Water
405 Lead and Copper Monitoring Data Report Water
406 Manual Interstitial Monitoring Monthly Log Water
407 Material Safety Data Sheet Reporting Water
408 Maximum Residual Disinfectant Level Input Form (Samples) Water
409 Maximum Residual Disinfectant Level Input Form (Sources) Water
410 Medical Waste Notification Form Waste/Remediation
411 Medical Waste Transporter Permit Application Waste/Remediation
412 Medical Waste Treatment Permit Application Waste/Remediation
414 Monthly Statistical Inventory Reconciliation (SIR) Report Water
415 Municipal POTW SSO/MS4 Event Reporting Form Water
416 Municipal Water Pollution Prevention (MWPP) Annual Report (Collection Systems) Package Water
417 Municipal Water Pollution Prevention (MWPP) Annual Report Package Water
418 Municipal Water Pollution Prevention Resolution Form Water
419 MWPP Sewage Sludge Survey Water
420 Non-Community Public Notification Certification Form Water
421 Non-Compliance Report Form Water
422 Notice of Intent to Permanently Close Underground Storage Tanks Water
423 Notice of Proposed UST New Installation or Upgrade Water
424 Notification - Above the Threshold Planning Quantities (TPQ) of Extremely Hazardous Substances Water
425 Notification of Election of Coverage under The Alabama Drycleaning Environmental Response Trust Fund Act Waste/Remediation
426 Nox Budget Permit Application Form Air
427 Nox Budget Retired Unit Exemption Claim Form Air
429 NPDES Annual Notice of Registration (NOR) Water
430 NPDES Discharge Monitoring Report Form (Monthly) Water
431 NPDES Discharge Monitoring Report Form (Quarterly) Water
432 NPDES Individual Permit Pollution Abatement/Treatment Measures and Sediment Control Structures Certification Report Water
433 NPDES Permitted Coalbed Methane Operations Pollution Abatement/Treatment Measures and Waste Treatment Facilities Certification Report Water
434 Open Burning Incident Report Air
435 Operator Certification Renewal Form Water
436 Perc Dry Cleaner Status Update Air
437 Permit Application for Compliance Schedule Air
438 Permit Application for Continuous Emission Monitoring Systems (CEMS) Air
439 Permit Application Solid Waste Disposal Facility Waste/Remediation
440 Petroleum Solvent Dry Cleaning Questionnaire Air
441 Plant and Collection System Personnel Inventory Water
442 Potable Water Laboratory Certification Application Water
443 Progress Report Form Water
444 Project Completion Form Water
445 PSD Project Information Form Air
446 Raw Sewage Bypass and Overflow Event Reporting Form Water
447 Release Information Form Water
448 Remediation Approval Form Air
449 Remediation Reporting Form Air
450 Representative Stormwater Outfall Certification Water
451 Request for Coal Permit Post-Mining Discharge Limitations Water
452 Request for Release from Monitoring and Reporting Requirements Water
453 Request to Remove Subsurface Withdrawal From Discharge Structure Water
454 Request to Remove Treatment Basin/Pond or Other Discharge Structure Water
455 Required Information for Mixing Zone Modeling Water
456 Segmental Water System Certification Application Water
457 SID Discharge Monitoring Report Form (Monthly) Water
458 SID Discharge Monitoring Report Form (Quarterly) Water
459 SRF Payment Request Form Water
460 Statistical Inventory Reconciliation SIR 7 Day Release Investigation Notice Form Water
461 Surface Source Susceptibility Analysis Worksheet Water
462 Tank Trust Fund Eligibility/Ineligibility Determination Form Water
464 Toxicity Discharge Monitoring Report Form Water
465 Toxicity Test Report Summary Water
466 Transfer Agreement Form Water
469 Underground and Above Ground Storage Tank Transfer of Ownership Water
471 UST ARBCA Tier 1 Report Forms Water
472 UST ARBCA Tier 2 Report Forms Water
473 UST ARBCA Tier 3 Report Forms Water
474 UST Closure Site Assessment Report Form Water
475 UST Free Product Recovery Report Form Water
476 UST Groundwater Monitoring Report Form Water
477 UST Line Tightness Test Report Form Water
478 UST Natural Attenuation Monitoring Report Form Water
479 UST Release Fact Sheet Water
480 UST Release Report Form Water
481 UST Site Classification System Checklist Water
482 UST System Effectiveness Monitoring Report Form Water
483 UST Tracer Tank Tightness Test Report Form Water
484 UST Ullage Tank Tightness Test Report Form Water
485 UST Vacuum Tank Tightness Test Report Form Water
486 UST Volumetric Overfill Tank Tightness Test Report Form Water
487 UST Volumetric Underfill Tank Tightness Test Report Form Water
488 Water Supply Construction Permit Application Water
489 Water Supply Permit Application (Modification) Water
490 Water Supply Permit Application (Renewal) Water
491 Water System Update Water
492 UST Closure Total Potential Voc Emissions Calculations Water
493 112 (j) Part 1 Applicability Notification Air
494 Birmingham Fuel Supplier Report Air
495 Major Source Operating Permit Skeleton Form Air
496 Notice of Demolition and/or Asbestos Removal Air
497 Asbestos Removal Contractor Certification Air
498 NPDES Construction, Noncoal/Nonmetallic Mining and Dry Procession Less than Five Acres, Other Land Disturbance Activities Application Form Water
499 NPDES Construction, Noncoal Mining Less than Five Acres Stormwater Registration Termination Request and Certification Form Water
500 NPDES Construction, and Noncoal Mining Less than Five Acres Stormwater Inspection Report and BMP Certification Form Water
501 NPDES Construction, and Noncoal Mining Less than Five Acres Stormwater Noncompliance Notification Report Form Water
502 Visible Emission Field Test Sheet Air
503 General Permit for Phase II Small Municipal Separate Storm Sewer Systems (MS4) ALNOI Water
505 Water and Wastewater Operator Exam Application Water
506 Water and Wastewater Operator Experience Verification Water
507 Water and Wastewater Reciprocal Application Water
508 Water and Wastewater Operator for Multiple Systems Water
510 Cooling Water Supplemental Information Water
511 EDMR1 Permittee Registration Form Water
512 EDMR2 Electronic Signature Application Agreement Water
513 EDMR3 Deactivation Request Form Water
514 Daily Discharge Monitor Report Water
515 Monthly Discharge Monitoring Report Water
516 Supplemental Petroleum Application Information Water
517 Alabama Clean Vessel Act Grant Application Water
518 Boating Infrastructure Grant Application Water
519 CAIR Permit Application Air
520 General Phase II MS 4 Stormwater Permit Renewal Notice of Intent Waste/Remediation
521 Voluntary Cleanup Program Application Form Waste/Remediation
522 Notice of Intent - Discharges of Filter Backwash Water, Sedimentation Basin Washdown, and Decant Water from Water Treatment Plants Water
530 Technical Proposal for Qualification as a Scrap Tire Fund Remediation Contractor Waste/Remediation
531 Hydrogeology Unit Evaluation Report Form Water
533 Documentation of Disability Related Needs Water
534 EHS Notification Form Water
535 CT Profiling Spreadsheet Water
536 Scrap Tire Manifest Waste/Remediation
537 Scrap Tire Registration & Exemption Application Waste/Remediation
538 Scrap Tire Transporter Permit Application Waste/Remediation
539 Scrap Tire Quarterly Report Waste/Remediation
540 Scrap Tire Processor Permit Application Waste/Remediation
541 Scrap Tire Site Registration Waste/Remediation
542 Brownfields State Revolving Fund PreApplication Form Waste/Remediation
543 Brownfields State Revolving Fund Application Fund Waste/Remediation
545 Cathodic Protection Monitoring for Galvanic Systems Waste/Remediation
546 Alabama Hazardous Waste Receipt for Samples and Documents Waste/Remediation
547 Water Treatment Plant Quarterly Report for the Disinfectants and Disinfection Byproducts Rule Water
548 Pollution Prevention Survey Air
549 NPDES Coalbed Methane Operation Water
550 Brownfields Assessment Request Application Waste/Remediation
551 ADEM Line Leak Detector (LLD) Test Report Form Water
8700-12 Notification of Regulated Waste Activity Waste/Remediation