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Site Remediation Reform Act (SRRA) Forms

Forms for Final Rule
Posted 7 May 2012

On May 7, 2012, the final Administrative Requirements for the Remediation of Contaminated Sites (ARRCS rules), N.J.A.C. 7:26C, the Discharges of Petroleum and Other Hazardous Substances rules, N.J.A.C. 7:1E, the Underground Storage Tanks rules, N.J.A.C. 7:14B, the Industrial Site Recovery Act rules, N.J.A.C. 7:26B, and the Technical Requirements for Site Remediation (Technical Requirements), N.J.A.C. 7:26E were published in the New Jersey Register.

The notice of adoption may be viewed at http://www.nj.gov/dep/rules/adoptions.html.

Important Changes to Forms:

General: Checkboxes indicating “Non-LSRP (Existing Cases)”, “LSRP” and “Subsurface Evaluator” have been removed from the Top Header of most forms. This change addresses the fact that all case related documents are to be submitted by LSRPs. Subsurface Evaluators will only use the Full Laboratory Data Deliverables form, Permit by Rule form, and IEC form (and appropriate forms from the UHOT website), therefore, the only forms listed below that still have a Subsurface Evaluator checkbox are these forms.

Remediation Timeframes Form: The Remediation Timeframe Notification Form has replaced the former Remediation Timeframe Extension Request Form. The new form contains two additional checkboxes: “Extension Request” or to “Lengthen the Remedial Investigation Report Timeframe.”

All forms required to comply with the Administrative Requirements for the Remediation of Contaminated Sites are contained on this web page. Additional forms will be provided as they are finalized. Unless otherwise noted in Instructions, all form submittals are to be directed to the following address:

Bureau of Case Assignment & Initial Notice
Site Remediation Program
NJ Department of Environmental Protection
401-05H
PO Box 420
Trenton, NJ 08625-0420

Current Forms Note:

The new forms will be required for submittals received by the Department dated May 7, 2012 or later.

Other SRP Forms

Related Links

Important Notices

NOTE: The PDF forms below are intended for the current versions (9.x or later) of the Adobe Reader. They might not be compatible with older versions of the reader. The Adobe Reader is available at http://get.adobe.com/reader/

help for using PDF documents

 

Form Download
Version &
Date
Changes Since Last Version Rule
7.5 Percent Cost of Remediation Form Form pdf 51 Kb Instructions pdf 32Kb 1.0 - 5/7/2012 (New)  
Alternative Remedy Application Form Form pdf 50 Kb Instructions pdf 37Kb 1.1 - 5/7/2012 See Update Log 7:26E-5.1(j)
Alternative Soil Remediation Standard Application Form pdf 131 Kb Instructions pdf 41 Kb 2.1 - 5/7/2012 See Update Log 7:26D-7.4

Annual Remediation Fee Reporting form

Form pdf 199 Kb Instructions pdf 44 Kb 1.5 - 5/25/2011 See Update Log 7:26C-4.2
Case Inventory Documents Worksheet Spreadsheet xls 20 Kb   1.0 - 11/4/2009    
Case Inventory Documents Example Sheet Example Sheet pdf 20 Kb   1.1 - 1/12/2011 Grammar & punctuation  
Guidance for the Preparation of the Case Inventory Documents Guidance Document pdf 43 Kb   1.1 - 1/12/2011 Grammar & punctuation  
CEA/Well Restriction Area (WRA) Fact Sheet form Form pdf 131 Kb Instructions pdf 46 Kb 1.3 - 5/7/2012 See Update Log 7:26E-6.3
CEA/Well Restriction Area (WRA) Spreadsheet Spreadsheet xls 37 Kb Instructions pdf 29 Kb 1/18/2012 New Document  
Confidentiality Request Form Form pdf 36 Kb Instructions pdf 28 Kb 1.1 - 5/7/2012 See Update Log 7:26C-15.3
Confirmed Discharge Notification form Form pdf 94 Kb Instructions pdf 36 Kb 1.6 - 5/7/2012 See Update Log 7:26E-1.4 
De Minimus Quantity Exemption Application form Formpdf 168 Kb Instructions pdf 40 Kb 1.3 - 5/25/2011 See Update Log 7:26B-5.9
Developer Certification (Appendix A for the ARRCS Rule) Model Document doc 39 Kb       7:26C-13.4 
Full Laboratory Data Deliverables form Form pdf 116 Kb Instructions pdf 35 Kb 1.4 - 5/7/2012 See Update Log 7:26E-1.18 
General Information Notification Form pdf 80 Kb Instructions pdf 32 Kb 1.7 - 5/7/2012 See Update Log 7:26B-3.3
Hazardous Discharge Site Remediation Fund Application form
Note: See the SRP Financial Assistance HDSRF page for more information & guidance.

Form pdf 347 Kb

Instructions pdf 51 Kb 1.2 - 5/25/2011 See Update Log 7:26C-11.2
HDSRF Application - Cost Estimate Format Spreadsheet Spreadsheet xls 110 Kb   1.0 - 5/21/2010    
IEC Response Action form Form pdf 89 Kb Instructions pdf 36 Kb 1.5 5/7/2012 See Update Log 7:26E-1.14  
IEC - Direct Contact Spreadsheet Spreadsheet xls 37 Kb   1.0 - 8/30/2011    
IEC - Potable Water Spreadsheet Spreadsheet xls 42 Kb   1.2 - 8/30/2010    
IEC - Vapor Intrusion Spreadsheet Spreadsheet xls 39 Kb   1.2 - 8/30/2010    
ISRA Alternate Compliance Option Application Form pdf 58 Kb Instructions pdf 35 Kb 1.5 - 5/7/2012 See Update Log 7:26C-5
ISRA Certificate of Limited Conveyance Application Form pdf 150 Kb Instructions pdf 44 Kb 1.0 - 5/25/2011 See Update Log  

Linear Construction Project

Form pdf 63Kb Instructions pdf 27 Kb 1.0 - 2/16/12   7:26C-16.2(a)2
LNAPL Free Product Reporting Form Form pdf 87 Kb Instructions 40 Kb 1.6 - 5/7/2012 See Update Log 7:26E-1.12
LSRP Notification of Retention or Dismissal Form pdf 62 Kb Instructions 36 Kb 3.0 - 5/7/2012 See Update Log 7:26C-2.3  
Model Termination of Deed Notice (Appendix B for the ARRCS Rule) Model Document doc 78 Kb       7:26C-13.4 
Monitoring Well Certification Form A - As-Built Certification Form pdf 32 Kb Instructions pdf 21 Kb 1.0 - 9/7/2011 New Document  
Monitoring Well Certification Form B - Location Certification Form pdf 22 Kb Instructions pdf 24Kb 1.1 - 11/28/2011 See Update Log  
Name and Address Change Reporting Form pdf 44 Kb   1.0 - 9/7/2011 New Document  

Negative Declaration (Only required for cases initiated before 11/4/2009)

Form pdf 163 Kb Instructions pdf 40 Kb 1.3 - 5/25/2011 See Update Log 7:26B-6.1 

Potable Well/Indoor Air Sampling Notification form

Form pdf 41 Kb Instructions pdf 33 Kb 1.4 - 5/7/2012 See Update Log 7:26E-1.4(e)

Sampling Notification Spreadsheet

Spreadsheet xls 42 Kb   1.0 - 2/4/2010    
Preliminary Assessment/Site Investigation form Form pdf 435 Kb Instructions pdf 51 Kb 1.6 - 5/7/2012 See Update Log 7:26E-3.1 & 3.3
Public Notification and Outreach form Form pdf 65 Kb Instructions pdf 49 Kb 1.6 - 5/7/2012 See Update Log 7:26E-1.4 
Petroleum UST Fund Application (Regulated) (Closes 6/30/2010) Form pdf 329 Kb Instructions pdf 60 Kb 1.1 - 3/4/2011 See Update Log 7:26C-12.2
Petroleum UST Fund Application (Unregulated) (Including Residential Heating Oil Tanks) Form pdf 338 Kb Instructions pdf 61 Kb 1.1 - 3/4/2011 See Update Log 7:26C-12.2
Project Summary Sheet Spreadsheet Spreadsheet xls 60 Kb   1.0    

Note: See the SRP Financial Assistance Petroleum UST Fund page for more information & guidance.

         
Receptor Evaluation form Form pdf 170 Kb Instructions pdf 50 Kb 1.7 - 5/7/2012 See Update Log 7:26E-1.15 
Well Search Spreadsheet Spreadsheet xls 155 Kb Instructions pdf 35 Kb 1.3 - 3/22/2012 See Update Log  
Remedial Action Report form Form pdf 356 Kb Instructions pdf 45 Kb 1.6 - 5/7/2012 See Update Log 7:26E-6.7
Remedial Action Workplan form Form pdf 391 Kb Instructions pdf 45 Kb 1.5 - 5/7/2012 See Update Log 7:26E-6.2
Remedial Action Permit Application Form for Ground Water Form pdf 148 Kb Instructions pdf 44 Kb 1.4 - 5/7/2012 See Update Log 7:26C-7 

Ground Water Monitoring Plan Spreadsheet
You may have to reset your macros security in Excel before it will open/work properly.
To reset: In a blank spreadsheet, go to TOOLS, MACROS, SECURITY. Set to MEDIUM. After that, open the spreadsheet, and select the button that says - Enable Macros.

Spreadsheet xls 177 Kb   1.0 - 5/22/2012  

 

Remedial Action Permit Application Form for Soils Form pdf 123Kb Instructions pdf 42 Kb 1.4 - 5/7/2012 See Update Log 7:26C-7 
Remedial Action Permit Transfer/Change of Ownership Application Form pdf 92 Kb Instructions pdf 37 Kb

1.2 - 5/7/2012

See Update Log  
Remedial Action Protectiveness / Biennial Certification Form - Ground Water
(Name change. Was "Remedial Action Protectiveness Certification Form - Ground Water")
Form pdf 195 Kb Instructions pdf 54 Kb

1.4 - 5/7/2012

See Update Log  

Remedial Action Protectiveness / Biennial Certification Form - Soil
(Name change. Was "Remedial Action Protectiveness Certification Form - Soils")

Form pdf 141 Kb 

Instructions pdf 36 Kb 1.6 - 5/7/2012 See Update Log 7:26E-8.4(c)
Remedial Investigation Report form Form pdf 374 Kb Instructions pdf 51 Kb 1.6 - 5/7/2012 See Update Log 7:26E-4.8
Remediation Certification form Form pdf 67 Kb Instructions pdf 30 Kb 1.5 - 5/7/2012 See Update Log 7:26B-4.3 

Remediation Cost Review and RFS-FA Form
Self Guarantee also requires the Self Guarantee Application

Form pdf 82 Kb Instructions pdf 33 Kb 1.2 - 9/7/2011 See Update Log 7:26C-5 
Remediation Timeframe Notification Form pdf 86 Kb Instructions pdf 37 Kb 1.0 - 5/7/2012 See (New) 7:26C-3.2  
Request to Proceed Without Department Pre-Approvals (The Opt In form) See the LSRP Notification of Retention or Dismissal form.         7:26C-2.3  
Response Action Outcome form Form pdf 272 Kb Instructions pdf 50 Kb 1.8 - 5/7/2012 See Update Log 7:26C-6.2 
Technical Assistance Grant form
See the Guidance for Technical Assistance Grants [pdf] for more information.
Form pdf 176 Kb Instructions pdf 35 Kb 1.3 - 5/25/2011 See Update Log 7:26C-10.5 
Underground Storage Tank System Closure Notification / Extension Request form Form pdf 183 Kb Instructions pdf 41 Kb 1.3 - 5/25/2011 See Update Log N.J.A.C. 7:14B-9.1(c). & 9.2
Vapor Concern (VC) Response Action Form   Form pdf 66Kb Instructions pdf 35 Kb 1.2 - 5/7/2012 See Update Log