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Lower High Falls, Talladega Forest - Bill Wilson
Water Division Forms

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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 appropriatw non-storm water form and Form 2F for their storm water. ADEM Form 187 and EPA Form 1 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 Program
008 Groundwater System Monthly Operational Data Report Water
014 Information Needed for 316(b) Determination in Regards to General NPDES Permits Water
020 Spill Catchment Basin/Spill Bucket 3 Year Test Log Water
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 - NPDES 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
031 Alabama Tank Trust Fund Cost Proposal Part 1 Water
032 Alabama Tank Trust Fund Payment Request Water
033 eDWRS Permittee Registration Form Water
034 eDWRS Lab Registration Form Water
035 eDWRS Terms and Conditions Agreement Water
036 Total Coliform Rule - Level 1 Assessment Water
037 Total Coliform Rule - Level 2 Assessment Water
060 Notification of Intent to Drill a Water Well Water
185 Purchase Water System Monthly Operation Report Water
186 State Indirect Discharge (SID) Permit Application Water
187 NPDES Individual Permit Application Supplementary Information for Industrial Facilities Water
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 Water
189 Permit Application for Reclaimed Water Use (RWR) 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
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
279 Notification for Underground Storage Tanks Water
283 Notification for Above Ground Storage Tanks Water
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 NPDES Individual Permit Application (Mining Operations) Water
318 Alabama Tank Trust Fund Cost Proposal Form Water
319 Alabama Tank Trust Fund Payment Request Form Water
324 Annual Certification Form for Discharges Associated with Petroleum Storage and Handling Areas Water
326 Annual Statistical Inventory Reconciliation (SIR) Report Form Water
332 Cathodic Protection Monitoring Form for Impressed Current Systems 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
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
369 Drinking Water State Revolving Fund (DWSRF) Loan Application Form Water
370 Drinking Water State Revolving Fund (DWSRF) Preapplication Form Water
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
380 Notice of Intent - NPDES General Permit Number ALG110000 Water
381 Notice of Intent - NPDES General Permit Number ALG120000 Water
382 Notice of Intent - NPDES General Permit Number ALG140000 Water
383 Notice of Intent - NPDES General Permit Number ALG150000 Water
384 Notice of Intent - NPDES General Permit Number ALG160000 Water
385 Notice of Intent - NPDES General Permit Number ALG170000 Water
386 Notice of Intent - NPDES General Permit Number ALG180000 Water
387 Notice of Intent - NPDES General Permit Number ALG020000 Water
388 Notice of Intent - NPDES General Permit Number ALG200000 Water
389 Notice of Intent - NPDES General Permit Number ALG230000 Water
390 Notice of Intent - NPDES General Permit Number ALG240000 Water
391 Notice of Intent - NPDES General Permit Number ALG250000 Water
392 Notice of Intent - NPDES General Permit Number ALG280000 Water
393 Notice of Intent - NPDES General Permit Number ALG030000 Water
394 Notice of Intent - NPDES General Permit Number ALG340000 Water
395 Notice of Intent - NPDES General Permit Number ALG360000 Water
396 Notice of Intent - NPDES General Permit Number ALG060000 Water
397 Notice of Intent - NPDES General Permit Number ALG670000 Water
400 Impressed Current Cathodic Protection System 60-Day Inspection Log 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
414 Monthly Statistical Inventory Reconciliation (SIR) Report Water
415 Sanitary Sewer Overflow (SSO) 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 NPDES/SID Non-Compliance Notification 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
429 NPDES Annual Notice of Registration (NOR) 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
435 Operator Certification Renewal Form Water
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
446 Raw Sewage Bypass and Overflow Event Reporting Form Water
447 Release Information Form Water
450 Representative Stormwater Outfall Certification Water
451 Request for NPDES Permit Post-Mining Discharge Limitations (Coal Mining Operations) Water
452 Request for Release from NPDES Permit Monitoring and Reporting Requirements (Mining Operations) Water
453 Request to Remove Subsurface Withdrawal From Discharge Structure (NPDES-Permitted Mining Operations) Water
454 Request to Remove Treatment Basin/Pond or Other Discharge Structure (NPDES-Permitted Mining Operations) 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 NPDES/SID Permit Transfer Agreement 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
498 Notice of Intent - NPDES General Permit Number ALG890000 Water
499 Notice of Termination - NPDES General Permit Number ALG890000 Water
500 NPDES Noncoal/Nonmetallic Mining and Dry Processing Less than Five Acres Stormwater Inspection Report and BMP Certification Water
501 ALG890000 Small Mining General Permit Noncompliance Notification Report Form Water
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 Permittee Registration Form for e-DMR/e-SSO Water
513 Deactivation Request Form for e-DMR/e-SSO 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
522 Notice of Intent - NPDES General Permit Number ALG640000 Water
531 Hydrogeology Unit Evaluation Report Form Water
533 Documentation of Disability Related Needs Water
534 EHS Notification Form Water
535 CT Profiling Spreadsheet Water
547 Water Treatment Plant Quarterly Report for the Disinfectants and Disinfection Byproducts Rule Water
549 NPDES Coalbed Methane Operation Water
551 ADEM Line Leak Detector (LLD) Test Report Form Water
552 Notice of Intent - UIC General Permit Number ALIG010000 Water
553 Notice of Intent - UIC General Permit Number ALIG020000 Water