Ala. Admin. Code r. 335-1-1-.01 - Departmental Forms, Instructions, And Procedures

(1) Designation as the State Environmental Control Agency. The Department is the State Environmental Control Agency for the purposes of federal environmental law including the Federal Clean Air Act, 42 U.S.C. 7401 et seq., as amended; the Federal Clean Water Act, 33 U.S.C. 1251 et seq., as amended; the Federal Safe Drinking Water Act, 42 U.S.C. A 201 et seq., as amended. The Department is authorized to take all actions necessary and appropriate to secure the benefits of federal environmental laws. The Department operates in conformity with such federal laws, policies, and procedures, as provided in the Act.

(2) Policies and Procedures. The Commission, through the adoption of rules pursuant to Code of Ala. 1975, § 22-22A-7(c)(6), establishes environmental policies and procedures.

(3) Form and Instructions. The Director may require such forms within the rules as he deems necessary. The content of such forms and instructions for their completion may be prescribed by the Director including the changes of such from time to time. Federal forms as published by the Environmental Protection Agency may be used in lieu of state developed forms. Departmental forms prescribed by the Director shall be identified and numbered as follows:

Name of Forms	Form Number
112 (j) Part 1 Applicability Notification	493
ADEM Baseline Monitoring Report Submittal Form	314
ADEM NPDES Individual Permit Application M-3	315
ADEM NPDES Pesticide Adverse Incident Report	29
ADEM Line Leak Detector (LLD) Test Report Form M-1	551
Air Permit Application For Gasoline Dispensing Facilities M-5	197
Alabama Clean Vessel Act Grant Application	517
Alabama Coastal Area Management Program Application for Approval of a Non-Regulated Use ADEM Administrative Code rule 335-8-1-.11 Groundwater Extraction 50 PM or Greater	316
Alabama Hazardous Waste Receipt for Samples and Documents	546
Alabama Hazardous Waste/Used Oil Transporter Permit Application	317
Alabama Recycling Fund Grant Application	9
Alabama Tank Trust Fund Cost Proposal Form	318
Alabama Tank Trust Fund Payment Request Form	319
Alternative Analysis	311
Alternative Medical Waste Treatment Technology Equipment Approval Application	323
Annual Certification Form for Discharges Associated with Petroleum Storage and Handling Areas M-1	324
Annual Containment Sump Inspection Log	19
Annual Recycling Report	16
Annual Statistical Inventory Reconciliation (SIR) Report Form	326
Application for a Permit for the Construction for a Motel, Hotel, or Other Multi-Unit Development on a Property Intersected by the Construction Control Line in the Alabama Coastal Area	327
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	328
Application for Alabama Well Driller's License M-1	193
Application for Approval of a Non-Regulated Use in the Alabama Coastal Area Developments and Subdivisions of Property Greater than 5 Acres in Size	329
Application for Approval to Use a Water Supply Well	259
Application for Name Change or Transfer of Permit or Exemption M-4	330
Asbestos Removal Contractor Certification	497
Birmingham Fuel Supplier Report M-4	494
Boating Infrastructure Grant Application	518
Brownfields Assessment Request Application	550
Brownfields State Revolving Fund Application Form	543
Brownfields State Revolving Fund Pre-Application Form	542
Bulk (Gasoline) Plant Application M-2	331
CAIR Permit Application (for sources covered under a CAIR SIP)	519
Calculation of Total Annualized Project Cost for Private-Sector Projects	313
Calculation of Total Annualized Project Cost for Public-Sector Projects	312
Cargo Tank Tightness Test Report M-l	309
Cathodic Protection Monitoring Form M-l	332
Cathodic Protection Monitoring for Galvanic Systems	545
CBM NPDES Stormwater Discharge Monitoring Report	333
CBM Toxicity Test Report Summary	334
Chemical Monitoring Data Report	335
Chemical Monitoring Waiver Application	336
Chemical Sampling Chain of Custody Form	337
Clean Water State Revolving Fund (CWSRF) Loan Application Form	339
Clean Water State Revolving Fund (CWSRF) Preapplication Form M-2	340
Coal Permit Precipitation Event Discharge Limitations Exemption Claim Report M-2	342
Coalbed Methane Stormwater Inspection Summary Report M-l	343
Coalbed Methane Temporary Pit Wastewater Land Application Certification Report M-1	344
Community Public Notification Certification Form	345
Community System Susceptibility Analysis Sheet	346
Composing Facility Application	18
Consumer Confidence Report Certification Form M-1	347
Cooling Water Supplemental Information M-1	510
CT Profiling Spreadsheet	535
Discharge Monitoring Report for CBM Coal - Type 60 Effluent	348
Discharge Monitoring Report for CBM Coal - Type 60 Manual	349
Discharge Monitoring Report for CBM Coal - Type 60 Standard	350
Discharge Monitoring Report for Coal - Type 1 & Type 3	351
Discharge Monitoring Report for Coal - Type 11	352
Discharge Monitoring Report for Coal - Type 13	353
Discharge Monitoring Report for Coal - Type 14 Sand & Gravel	354
Discharge Monitoring Report for Coal - Type 14 Fire Clay	355
Discharge Monitoring Report for Coal - Type 14 Shale -Common Clay	356
Discharge Monitoring Report for Coal - Type 15	357
Discharge Monitoring Report for Coal - Type 38	358
Discharge Monitoring Report for Coal - Type 5 & Type 7	359
Discharge Monitoring Report for Coal - Type 9	360
Discharge Monitoring Report for NonCoal - Type 30	361
Discharge Monitoring Report for NonCoal - Type 32	362
Discharge Monitoring Report for NonCoal - Type 34	363
Discharge Monitoring Report for NonCoal - Type 36 & Type 48 & Type 50	364
Discharge Monitoring Report for NonCoal - Type 41	365
Discharge Monitoring Report for NonCoal - Type 42	366
Discharge Monitoring Report for NonCoal - Type 44 & Type 45	367
Discharge Monitoring Report for NonCoal - Type 46	368
Disposal Approval Request	278
Documentation of Disability Related Needs	533
Drinking Water State Revolving Fund (DWSRF) Loan Application Form	369
Drinking Water State Revolving Fund (DWSRF) Preapplication Form M-2	370
EDMR-1 Permittee Registration Form	511
EDMR-2 Electronic Signature Application Agreement	512
EDMR-3 Deactivation Request Form	513
EDMR Daily Discharge Monitoring Report Form	514
EDMR Monthly Discharge Monitoring Report Form	515
EHS Notification Form	534
Emissions Statement Reporting Form M-1	372
Excess Emission Monitoring Report	373
Exemption Claim Form for Cofired Combustors (Appendix H -Division 3)	374
Exemption Claim Form for Incinerators Burning Only Pathological, Low-Level Radioactive, and Chemotherapeutic Waste (Appendix H - Division 3)	375
NPDES Individual Permit Application Addendum M-1	376
NPDES Individual Permit Application Minor Permit Modification Addendum M-1	377
Gasoline Dispensing Facility Information Survey M-1	378
Gasoline Transport Tank Truck Application M-2	198
General Permit ALR100000 Facility Sign	22
General Permit Application Package - NOI-11 M-2	380
General Permit Application Package - NOI-12 M-2	381
General Permit Application Package - NOT-14 M-2	382
General Permit Application Package - NOI-15 M-1	383
General Permit Application Package - NOI-16 M-1	384
General Permit Application Package - NOI-17 M-1	385
General Permit Application Package - NOI-18 M-1	386
General Permit Application Package - NOT-2 M-1	387
General Permit Application Package - NOI-20 M-1	388
General Permit Application Package - NOI-23 M-1	389
General Permit Application Package - NOI-24 M-1	390
General Permit Application Package - NOI-25 M-2	391
General Permit Application Package - NOI-28 M-3	392
General Permit Application Package - NOT-3 M-1	393
General Permit Application Package - NOI-34 M-1	394
General Permit Application Package - NOI-36 M-3	395
General Permit Application Package - NOT-6 M-1	396
General Permit Application Package - NOI-67 M-1	397
General Permit Application Package - NOI-64 M-1	522
General Phase II MS4 Stormwater Permit Renewal	520
General Permit for Phase II Small Municipal Separate Storm Sewer Systems (MS4) ALNOI M-2	503
General Permit Renewal Form M-1	398
Groundwater System Monthly Operational Data Report	8
Hydrogeology Unit Evaluation Report Form	531
Hydrograph Control Release (HCR) Attachment	399

Name of Forms	Form Number
Impressed Current Cathodic Protection System 60-Day Inspection Log	400
Individual NPDES Permit Noncompliance Notification (5-day Report)	401
Information Needed for 316 (b) Determination in Regards to General NPDES Permits	14
Interior Lining Inspection Form	403
Interior Lining Report Form	404
Joint Application and Notification U. S. Department of Army, Corps of Engineers Alabama Department of Environmental Management M-l	166
Lead and Copper Monitoring Data Report	405
Major Source Operation Permit Skeleton Form	495
Manual Interstitial Monitoring Monthly Log	406
Material Safety Data Sheet Reporting	407
Maximum Residual Disinfectant Level Input Form (Samples)	408
Maximum Residual Disinfectant Level Input Form (Sources)	409
Medical Waste Notification Form M-1	410
Medical Waste Transporter Permit Application M-4	411
Medical Waste Treatment Permit Application M-4	412
Monthly Filter Plant Monthly Operational Data Report M-4	242
Monthly Membrane Surface Plant Operational Data Report	243
Monthly Statistical Inventory Reconciliation (SIR) Report	414
Municipal POTW SS0/MS4 Event Reporting Form M-l	415
Municipal Water Pollution Prevention (MWPP) Annual Report (Collection Systems) Package M-l	416
Municipal Water Pollution Prevention (MWPP) Annual Report Package M-2	417
Municipal Water Pollution Prevention Resolution Form	418
MWPP Sewage Sludge Survey	419
Non-Community Public Notification Certification Form	420
Non-Compliance Report Form M-2	421
Notice of Demolition and/or Asbestos Removal M-l	496
Notice of Intent-General Permit ALR100000	24
Notice of Intent-General Permit ALG850000	26
Notice of Intent-General Permit ALG870000	28
Notice of Intent to Permanently Close Underground Storage Tanks M-1	422

Name of Forms	Form Number
Notice of Proposed UST New Installation or Upgrade M-l	423
Notice of Temporary Closure M-l	310
Notice of Termination-General Permit Number ALG870000	30
Notification - Above the Threshold Planning Quantities (TPQ) of Extremely Hazardous Substances	424
Notification for Above Ground Storage Tanks M-1	283
Notification for Underground Storage Tanks M-1	279
Notification of Election of Coverage under The Alabama Drycleaning Environmental Response Trust Fund Act	425
Notification of Intent to Drill a Water Well	60
Notification of Regulated Waste Activity M-2	8700-12
N0X Budget Permit Application Form	426
N0X Budget Retired Unit Exemption Claim Form	427
NPDES Annual Notice of Registration (NOR)	429
NPDES Coalbed Methane Operation M-2	549
NPDES Noncoal/Nonmetallic Mining and Dry Processing Less than Five Acres, Program Notice of Registration Form M-2	498
NPDES Noncoal/Nonmetallic Mining and Dry Processing Less than Five Acres Stormwater Inspection Report and BMP Certification Form M-l	500
NPDES Noncoal/Nonmetallic and Dry Processing Less than Five Acres Stormwater Noncompliance Notification Report Form M-1	501
NPDES Construction, Noncoal Mining Less than Five Acres Stormwater Registration Termination Request and Certification Form M-1	499
NPDES Construction Stormwater Inspection Report and BMP Certification	23
NPDES Construction Stormwater Noncompliance Notification	25
NPDES Discharge Monitoring Report Form (Monthly)	430
NPDES Discharge Monitoring Report Form (Quarterly)	431
NPDES Individual Permit Pollution Abatement/Treatment Measures and Sediment Control Structures Certification Report M-2	432
NPDES Permit Application Semi-Public And Private Facilities M-1	188
NPDES Permit Application Supplementary Information M-3	187
NPDES Permitted Coalbed Methane Operations Pollution Abatement/Treatment Measures and Waste Treatment Facilities Certification Report M-l	433
Open Burning Incident Report	434
Operating Permit Application Facility Identification Form M-5	103

Name of Forms	Form Number
Operational Evaluation Level Exceedance Report	27
Operator Certification Renewal Form M-1	435
Perc Dry Cleaner Status Update M-1	436
Permit Application for Air Pollution Control Device M-2	110
Permit Application for Compliance Schedule M-1	437
Permit Application for Continuous Emission Monitoring Systems (CEMS)	438
Permit Application for Indirect Heating Equipment M-1	104
Permit Application for Loading and Storage of Organic Compounds M-1	108
Permit Application for Manufacturing or Processing Operation M-3	105
Permit Application Solid Waste Disposal Facility	439
Permit Application Solid Waste Disposal Facility Construction/Demolition Landfill	305
Permit Application for Solvent Metal Cleaning	112
Permit Application for Stationary Internal Combustion Engines M-5	107
Permit Application for Volatile Organic Compound Surface Coating Emission Source M-2	109
Permit Application for Waste Disposal	106
Petroleum Solvent Dry Cleaning Questionnaire	440
Plant and Collection System Personnel Inventory	441
Pollution Prevention Survey	548
Potable Water Laboratory Certification Application M-2	442
Processing and Recycling General Information	15
Progress Report Form	443
Project Completion Form	444
PSD Project Information Form	445
Purchase Water System Monthly Operation Report	185
Raw Sewage Bypass and Overflow Event Reporting Form	446
Registration Form for the Construction, Installation, or Modification of an Incinerator M-2	52
Release Information Form	447
Remediation Approval Form M-2	448
Remediation Reporting Form M-2	449
Representative Stormwater Outfall Certification M-2	450
Request for Coal Permit Post-Mining Discharge Limitations M -1	451
Request for Release from Monitoring and Reporting Requirements M-l	452
Request to Remove Subsurface Withdrawal From Discharge Structure M-l	453
Request to Remove Treatment Basin/Pond or Other Discharge Structure M-l	454
Required Information for Mixing Zone Modeling M-l	455
SARA Title III Section 302 Notification	302
Scrap Tire Manifest M-3	536
Scrap Tire Processor Permit Application M-3	540
Scrap Tire Quarterly Report M-3	539
Scrap Tire Registration & Exemption Application M-4	537
Scrap Tire Site Registration	541
Scrap Tire Transporter Permit Application M-4	538
Seal Gap Test Form	184
Segmental Water System Certification Application	456
SID Discharge Monitoring Report Form (Monthly)	457
SID Discharge Monitoring Report Form (Quarterly)	458
Solid Waste Landfill Operator Certification Renewal	13
Solid Waste Landfill Operator Initial Certification Application	11
Solid Waste Landfill Operator Reciprocal Certification Application	12
Solid Waste Profile Sheet	300
Specifications for Air Curtain Incinerators	17
Spill Catchment Basin/Spill Bucket Annual Test Log	20
SRF Payment Request Form	459
State Indirect Discharge Permit Application M-4	186
Statistical Inventory Reconciliation SIR 7 Day Release Investigation Notice Form	460
Supplemental Petroleum Application Information	516
Surface Source Susceptibility Analysis Worksheet	461
Tank Trust Fund Eligibility/Ineligibility Determination Form	462
Technical Proposal for Qualification as a Large Site Scrap Tire Fund Remediation Center M-l	530
Termination Request-General Permit Number ALR100000	21

Name of Forms	Form Number
Toxicity Discharge Monitoring Report Form	464
Toxicity Test Report Summary	465
Transfer Agreement Form	466
UIC Permit Application for Coal Mining Wastewater M-l	532
Underground and Above Ground Storage Tank Transfer of Ownership M-l	469
UST ARBCA Tier 1 Report Forms	471
UST ARBCA Tier 2 Report Forms	472
UST ARBCA Tier 3 Report Forms	473
UST Closure Site Assessment Report Form M-2	474
UST Closure Total Potential VOC Emissions Calculations	492
UST Free Product Recovery Report Form	475
UST Groundwater Monitoring Report Form	476
UST Line Tightness Test Report Form M-l	477
UST Natural Attenuation Monitoring Report Form	478
UST Release Fact Sheet	479
UST Release Report Form M-2	480
UST Site Classification System Checklist	481
UST System Effectiveness Monitoring Report Form	482
UST Tracer Tank Tightness Test Report Form M-l	483
UST Ullage Tank Tightness Test Report Form M-l	484
UST Vacuum Tank Tightness Test Report Form	485
UST Volumetric Overfill Tank Tightness Test Report Form M-l	486
UST Volumetric Underfill Tank Tightness Test Report Form	487
Visible Emission Field Test Sheet	502
Voluntary Cleanup Program Application	521
Water Supply Construction Permit Application M-l	488
Water Supply Permit Application (Modification)	489
Water Supply Permit Application (Renewal) M-l	490
Water System Update	491
Water Treatment Plant Quarterly Report for the Disinfectants and Disinfection Byproducts Rule M-l	547
Water and Wastewater Operator Exam Application M-l	505
Water and Wastewater Operator Experience Verification M-l	506
Water and Wastewater Operator for Multiple Systems M-l	508
Water and Wastewater Reciprocal Application M-l	507
Water Well Driller Reciprocal Application	194
Water Well Standards Program License Renewal	195

Notes

Ala. Admin. Code r. 335-1-1-.01

Amended: Filed June 26, 2002; effective July 31, 2002. Amended: Filed December 19, 2002; effective January 23, 2003. Amended: Filed June 30, 2004; effective August 4, 2004. Amended: Filed December 6, 2005; effective January 10, 2006. Amended: Filed June 6, 2006; effective July 11, 2006. Amended: Filed October 10, 2006; effective November 14, 2006. Amended: Filed December 18, 2007; effective January 22, 2008. Amended: Filed December 15, 2008; effective January 19, 2009. Amended: Filed December 15, 2009; effective January 19, 2010. Amended: Filed December 14, 2010; effective January 18, 2011. Amended: Filed October 25, 2011; effective November 29, 2011. Amended: Filed October 23, 2012; effective November 27, 2012. Amended: Filed April 15, 2014; effective May 20, 2014.

Rule .07 was renumbered to .01 as per certification filed April 15, 2014; effective May 20, 2014.

Authors: Marilyn Elliott, Russell A. Kelly

Statutory Authority: Code of Ala. 1975, §§ 22-22A-5, 22-22A-6, 22-22A-8, 411-22-4, 41-22-5.