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Site Remediation Reform Act (SRRA) Forms

The SRRA Forms Page is in four sections: 1) NJDEP Online Services, 2) RAO, Receptor Evaluation and CEA Forms, and 3) Remedial Action Permit Forms, and 4) General Forms.

NJDEP Online Forms

This section contains all the forms that are available for submission using NJDEP Online, the CID and authorization form required to be completed and uploaded in some submissions.

RAO, Receptor Evaluation and CEA Forms

This section consolidates the RAO forms and common form submittals that accompany the remedial phase reports. The common information fields of these forms have been moved to the "Cover/Certification Form" to eliminate redundancy when submitting multiple remedial phase forms at one time.

General

This section contains the remaining forms which do not fit into the above two sections.

Note several forms have been renamed as follows:

  • Name and Address Change Reporting Form is now "Site and Contact Information Update Form;"
  • De Minimis Quantity Exemption Application Form is now "ISRA De Minimis Quantity Exemption Application Form;"
  • General Information Notification Form is now "ISRA General Information Notification Form;"
  • Remediation Certification Form is now "ISRA Remediation Certification Form;" and
  • Remedial Action Permit Transfer/Change of Ownership Application is now the "Remedial Action Permit Transfer/Change of Property Ownership Application".

Unless otherwise noted in Instructions, all form submittals are to be directed to the following address:

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

Forms without payments or online services can also be emailed to srp_submissions@dep.nj.gov.

For forms related to RCRA, CERCLA, Federal Facilities, and Traditional Oversight, and Direct Oversight, click here.

Related Links

Disclaimer

Users of this information should not consider these materials the sole source of information sufficient in itself to dictate any outcome or decision on the remediation of a contaminated site but should refer to the Department's rules and guidance provided on SRP's web site.

 
NJDEP Online Services Download
 Version & Date Changes Since Last Version Rule
Annual Remediation Fee Reporting
Pay/Update Online (Requires Login, Service must be Certified by an LSRP) 		  Instructions [pdf] 1.4 - 6/15/2015 See Update Log 7:26C-4.3
Case Inventory Document Worksheet Spreadsheet [xlsm]   1.5.1 - 2/4/2021 See Update Log  
Case Inventory Document Instructions   Instructions [pdf] 1.6 - 1/26/2023 See Update Log  
Confirmed Discharge Notification (CDN)
Submit Confirmed Discharge Notification Online. (Requires Login) 		FAQs [pdf] Instructions [pdf] 1.4 - 10/1/2019 See Update Log  
General Information Notice (GIN)
Submit General Information Notice Online. (Requires Login) 		FAQs [pdf] Instructions [pdf] 1.1 - 12/4/2018 See Update Log  
Authorization Form To Submit A Confirmed Discharge Notification (CDN)
or General Information Notice (GIN) through NJDEP Online 		Form [pdf] Instructions [pdf] 1.0 - 10/11/2017    
LSRP Notification of Retention or Dismissal
Submit LSRP Notification Online. (Requires Login, Service must be Certified by an LSRP) 		  Instructions [pdf] 1.3 - 11/22/2021 See Update Log 7:26C-2.3
Public Notification and Outreach Service
Submit Public Notification and Outreach form Online. (Requires Login, Service must be Certified by an LSRP)		   Instructions [pdf] 1.2 - 1/18/2022 See Update Log  
Public Notification and Outreach Form Form [pdf] Instructions [pdf] 2.3 - 9/1/2020 See Update Log  
Child Care PA, Clean PASI, or Clean SI Standalone Report Submissions
Submit Child Care PA, Clean PASI, or Clean SI Standalone Report Online. (Requires Login, Service must be Certified by an LSRP) 		  Instructions [pdf] 1.1 - 8/17/2022 See Update Log  
Preliminary Assessment Report Service
Submit PA Online. (Requires Login, Service must be Certified by an LSRP) 		FAQs [pdf] Instructions [pdf] 1.3 - 6/7/2022 See Update Log  
Preliminary Assessment/Site Investigation Report Service
Submit PA/SI Online. (Requires Login, Service must be Certified by an LSRP) 		FAQs [pdf] Instructions [pdf] 1.2 - 1/15/2020 See Update Log  
Site Investigation Report Service
Submit SI Online. (Requires Login, Service must be Certified by an LSRP) 		FAQs [pdf] Instructions [pdf] 1.2 - 1/15/2020 See Update Log  
Remedial Investigation Report Online Service
Submit RIR Online. (Requires Login, Service must be certified by an LSRP) 		FAQs [pdf] Instructions [pdf] 1.6 - 2/22/2022 See Update Log 7:26E-4.9
Remedial Action Workplan Online Service
Submit RAW Online. (Requires Login, Service must be certified by an LSRP) 		FAQs [pdf] Instructions [pdf] 1.4 - 2/22/2022 See Update Log  
Remedial Action Report Online Service
Submit RAR Online. (Requires Login, Service must be certified by an LSRP) 		FAQs [pdf] Instructions [pdf] 1.5 - 2/22/2022 See Update Log  
Response Action Outcome Online Service
Submit RAO Online. (Requires Login, Service must be certified by an LSRP) 		FAQs [pdf] Instructions [pdf] 1.2 - 6/7/2022 See Update Log  
Authorization To Submit a Report / Form through NJDEP Online
Note: This form replaces the "Authorization To Submit a Remedial Phase Report through NJDEP Online". 		Form [pdf] Instructions [pdf] 1.3 - 1/3/2022 See Update Log  
Underground Storage Tank Notice of Intent to Close
Submit UST NOI Online. (Requires Login, Service must be certified by an LSRP) 		  Instructions [pdf] 1.0 - 10/3/2016 See Update Log 7:14B-9.2
RAO, Receptor Evaluation and CEA Forms Download
 Version & Date Changes Since Last Version Rule
Cover/Certification Form
(Must be submitted with the forms listed below unless submitted online) 		Form [pdf] Instructions [pdf] 1.1 - 9/17/2018 See Update Log  
Response Action Outcome form Form [pdf] Instructions [pdf] 3.4 - 11/15/2019 See Update Log 7:26C-6.2 
Response Action Outcome Notices Word Document [doc]        
Model Response Action Outcome (Appendix D for the ARRCS Rule) Model Document [doc]        
Receptor Evaluation form Form [pdf] Instructions [pdf] 2.5 - 6/28/2021 See Update Log 7:26E-1.12
Well Search Spreadsheet Spreadsheet [xls] Instructions [pdf] 1.3 - 3/22/2012 See Update Log  
CEA/Well Restriction Area (WRA) Fact Sheet form Form [pdf] Instructions [pdf] 1.9 - 9/18/2018 See Update Log 7:26C-7.3
Remedial Action Permit Forms Download
 Version & Date Changes Since Last Version Rule
Financial Assurance (FA)          
Remediation Trust Fund Agreement for FA - Please see N.J.A.C. 7:26C-5.4 for specific requirements Remediation Trust Fund Agreement for FA N.J.A.C. 7:26C-5.4      
Line of Credit Agreement for FA - Please see N.J.A.C. 7:26C-5.6 for specific requirements. Line of Credit Agreement for FA N.J.A.C. 7:26C-5.6      
Letter of Credit for FA - Please see N.J.A.C. 7:26C-5.7 for specific requirements. Letter of Credit for FA N.J.A.C. 7:26C-5.7      
Environmental Insurance Policy - Please see DEP's regulatory requirements at N.J.A.C. 7:26C-5.5.   N.J.A.C. 7:26C-5.5      
Surety Bond - Please see N.J.S.A. 58:10B-3.i for specific requirements. Surety Bond        
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]   1.0 - 5/22/2012  

 
Model Deed Notice (Appendix B for the ARRCS Rule) Model Document [doc]   5/8/2018 See Update Log 7:26C-7.2
Model Termination of Deed Notice (Appendix C for the ARRCS Rule) Model Document [doc]   5/8/2018 See Update Log 7:26C-7.13 
Remedial Action Permit Contact Information Change
(Name change. Was "Remedial Action Permit Transfer/Change of Property Ownership Application and Contact Information Changes") 		Form [pdf] Instructions [pdf] 1.2 - 1/27/2023 See Update Log  
Remedial Action Permit Transfer/Change of Property Ownership Application
(Name change. Was "Remedial Action Permit Transfer/Change of Property Ownership Application and Contact Information Changes") 		Form [pdf] Instructions [pdf] 2.8 - 6/2/2022 See Update Log 7:26C-7.11
Remedial Action Permit Initial Application - Ground Water Form [pdf] Instructions [pdf] 1.6 - 1/27/2023 See Update Log  
Remedial Action Permit Modification Application - Ground Water Form [pdf] Instructions [pdf] 1.5 - 1/27/2023 See Update Log  
Remedial Action Permit Termination Application - Ground Water Form [pdf] Instructions [pdf] 1.5 - 1/27/2023 See Update Log  
Remedial Action Permit Initial Application - Soil Form [pdf] Instructions [pdf] 1.6 - 1/27/2023 See Update Log  
Remedial Action Permit Modification Application - Soil Form [pdf] Instructions [pdf] 1.6 - 1/27/2023 See Update Log  
Remedial Action Permit Termination Application - Soil Form [pdf] Instructions [pdf] 1.4 - 6/2/2022 See Update Log  
Remedial Action Protectiveness / Biennial Certification Form - Ground Water
(Name change. Was "Remedial Action Protectiveness Certification Form - Ground Water")		 Form [pdf] Instructions [pdf] 2.1 - 1/27/2023 See Update Log 7:26C-7.7
Remedial Action Protectiveness / Biennial Certification Form - Soil
(Name change. Was "Remedial Action Protectiveness Certification Form - Soils")		 Form [pdf] Instructions [pdf] 2.1 - 1/27/2023 See Update Log 7:26C-7.7
Termination of Deed Notice Form Form [pdf] Instructions [pdf] 1.2 - 6/2/2022 See Update Log  
General Forms Download
 Version & Date Changes Since Last Version Rule
7.5 Percent Cost of Remediation Form Form [pdf] Instructions [pdf] 1.1 - 9/17/2018 See Update Log 7:26C-4.10
Alternative or New Remediation Standard and/or Screening Level Application form
(Name change. Was "Alternative Soil Remediation Standard and/or Screening Level Application form") 		Form [pdf] Instructions [pdf] 2.4 - 5/3/2021 See Update Log 7:26D-7.4
Remediation Standard Notification Spreadsheet SpreadSheet [xls]   1.1 - 5/3/2021 See Update Log  
Alternative Remedy/Remedial Action Pre-Approval Form Form [pdf] Instructions [pdf] 1.5 - 9/17/2018 See Update Log 7:26C-5.3(c)
Case Creation Request form
Note: This form is for filing a (CDN) for Historic Fill only, or creating a case for Madden Subject Educational Facility,
or creating a case where there is no Statutory or Regulatory Requirement, but remediation conducted for the purpose
of obtaining a Response Action Outcome (RAO).		 Form [pdf] Instructions [pdf] 1.0 - 12/3/2018   7:26C-1.7
Child Care Center/Educational Facility Remediation Form Form [pdf] Instructions [pdf] 1.2 - 5/26/2020 See Update Log P.L. 2007 Chapter 1
Confidentiality Request Form Form [pdf] Instructions [pdf] 1.2 - 4/1/2015 See Update Log 7:26C-15.3
Developer Certification (Appendix A for the ARRCS Rule) Model Document [doc]       7:26C-4.7 
Discharge to Ground Water Permit by Rule Authorization Request Form [pdf] Instructions [pdf] 1.2 - 9/17/2018 See Update Log 7:26E-5.6
Exemption from Spill Act Liability Certification Form [pdf] Instructions [pdf] 1.1 - 4/2/2013 See Update Log 7:26C-1.4(f)
Full Laboratory Data Deliverables form Form [pdf] Instructions [pdf] 1.8 - 8/26/2021 See Update Log 7:26E-1.11, 14 & 15 
Hazardous Discharge Site Remediation Fund Application form
Note: See the SRP Financial Assistance HDSRF page for more information & guidance.		 Form [pdf] Instructions [pdf] 1.5 - 9/17/2018 See Update Log 7:26C-11.2
HDSRF Child Care Facility Grant Application Form [pdf] Instructions [pdf] 1.2 - 10/24/2016 See Update Log 7:26C-11.2
Historically Applied Pesticides Deferral Request Form [pdf] Instructions [pdf] 1.2 - 11/21/2019 See Update Log  
IEC Response Action form Form [pdf] Instructions [pdf] 1.8 - 1/6/2023 See Update Log 7:26E-1.11  
IEC - Direct Contact Spreadsheet Spreadsheet [xls]   1.1 - 3/26/2015 See Update Log  
IEC - Potable Water Spreadsheet Spreadsheet [xls]   1.3 - 3/26/2015 See Update Log  
IEC/VC - Vapor Intrusion Spreadsheet Spreadsheet [xls]   1.3 - 3/26/2015 See Update Log  
IEC Monitoring and Maintenance Checklist Form [pdf]   1.1 - 3/16/2018 See Update Log  
ISRA Alternate Compliance Option Application Form [pdf] Instructions [pdf] 2.0 - 11/10/2020 See Update Log 7:26B-5
ISRA Certificate of Limited Conveyance Application Form [pdf] Instructions [pdf] 1.1 - 7/24/2012 See Update Log 7:26B-5.7
ISRA De Minimis Quantity Exemption Affidavit Application
(Formerly De Minimus Quantity Exemption Application) 		Form [pdf] Instructions [pdf] 1.6 - 8/7/2019 See Update Log 7:26B-5.9
ISRA General Information Notice for Confidential Submissions Only
Note: Submit along with Confidentiality Form, all other GINs use online service above. 		Form [pdf] Instructions [pdf] 2.0 - 12/3/2018 See Update Log 7:26B-3.2
ISRA Remediation Certification form
(Formerly Remediation Certification form)		 Form [pdf] Instructions [pdf] 2.0 - 11/21/2022 See Update Log 7:26B-3.3 
Linear Construction Project Form [pdf] Instructions [pdf] 1.1 - 9/17/2018 See Update Log 7:26C-16.2(a)2
LNAPL Free Product Reporting Form Form [pdf] Instructions [pdf] 1.7 - 9/17/2018 See Update Log 7:26E-1.10(b)
Monitoring Well Certification Form A - As-Built Certification Form [pdf] Instructions [pdf] 1.0 - 9/7/2011 See Update Log 7:26E-1.6
Monitoring Well Certification Form B - Location Certification Form [pdf] Instructions [pdf] 1.3 - 2/26/2013 See Update Log 7:26E-1.6
Notice of Failure to Comply with a Mandatory or Expedited Site-specific Remediation Timeframe Form [pdf] Instructions [pdf] 1.0 - 4/27/2016 See Update Log 7:26I-6.8(c)
Out of Service Extension Request for an Underground Storage Tank System
(Name change. Was "Underground Storage Tank System Closure Notification / Extension Request form") 		Form [pdf] Instructions [pdf] 1.5 - 9/17/2018 See Update Log 7:14B-9.1
Petroleum UST Fund Application (Regulated) (Closes 6/30/2010) Form [pdf] Instructions [pdf] 1.2 - 9/17/2018 See Update Log 7:26C-12.2
Petroleum UST Fund Application (Unregulated) (Including Residential Heating Oil Tanks) Form [pdf] Instructions [pdf] 1.2 - 9/17/2018 See Update Log 7:26C-12.2
Project Summary Sheet Spreadsheet
Note: See the SRP Financial Assistance Petroleum UST Fund page for more information & guidance.		 Spreadsheet [xls]   1.0    
Pre-Purchase Administrative Consent Order Certification Form [pdf] Instructions [pdf] 1.0 - 9/2/2022 See Update Log 7:26C-3.2
Remedial Timeframe Notification Form [pdf] Instructions [pdf] 1.3 - 9/17/2018 See Update Log 7:26C-3.2
Remediation Cost Review and RFS-FA Form Form [pdf] Instructions [pdf] 2.2 - 9/23/2020 See Update Log 7:26C-5 
RFS/FA Model Financial Mechanism Language RFS Guide Page        
Self Guarantee Application Form [pdf] Instructions [pdf] 1.3 - 6/12/2014 See Update Log 7:26C-5 
Site and Contact Information Update Form
(Name change. Was "Name and Address Change Reporting" form)		 Form [pdf] Instructions [pdf] 1.3 - 10/18/2017 See Update Log  
Technical Assistance Grant form
See the Guidance for Technical Assistance Grants [pdf] for more information. 		Form [pdf] Instructions [pdf] 1.4 - 9/17/2018 See Update Log 7:26C-10.5 
Underground Storage Tank Forms UST Forms Page        
Vapor Concern (VC) Response Action Form   Form [pdf] Instructions [pdf] 1.5 - 1/6/2023 See Update Log 7:26C-1.15
Variance Identification Form Form [pdf]