Skip to main navigation Skip to main content
Underground Storage Tank Branch

2019 Regulatory Amendments & Forms Effective April 5, 2019

​2019 Regulatory Amendments

Effective April 5, 2019

2019 Forms
DownloadTypeFile Size
DWM 4220 - UST Annual Walkthrough Inspection.docxdocx61078
DWM 4220 - UST Annual Walkthrough Inspection.pdfpdf201998
DWM 4221 - UST Automatic Line Leak Detector Operational Test.docxdocx68331
DWM 4221 - UST Automatic Line Leak Detector Operational Test.pdfpdf240407
DWM 4222 - UST Containment Device Test.docxdocx51049
DWM 4222 - UST Containment Device Test.pdfpdf135784
DWM 4223 - UST Electronic Release Detection Equipment Test.docxdocx54527
DWM 4223 - UST Electronic Release Detection Equipment Test.pdfpdf147229
DWM 4224 - UST Facility Owner Address Correction.docxdocx48540
DWM 4224 - UST Facility Owner Address Correction.pdfpdf159767
DWM 4225 - UST Facility Registration.docxdocx78753
DWM 4225 - UST Facility Registration.pdfpdf256026
DWM 4226 - UST Galvanic Cathodic Protection Evaluation.docxdocx74140
DWM 4226 - UST Galvanic Cathodic Protection Evaluation.pdfpdf209413
DWM 4227 - UST Impressed Current Cathodic Protection Evaluation.docxdocx79573
DWM 4227 - UST Impressed Current Cathodic Protection Evaluation.pdfpdf258161
DWM 4228 - UST Integrity Assessment.docxdocx51883
DWM 4228 - UST Integrity Assessment.pdfpdf141938
DWM 4229 - UST Line Tightness Test.docxdocx54399
DWM 4229 - UST Line Tightness Test.pdfpdf148964
DWM 4230 - UST Monthly Walkthrough Inspection.docxdocx70469
DWM 4230 - UST Monthly Walkthrough Inspection.pdfpdf201906
DWM 4231 - UST Notice of Intent to Install Underground Storage Tank or Piping.docxdocx45440
DWM 4231 - UST Notice of Intent to Install Underground Storage Tank or Piping.pdfpdf145685
DWM 4232 - UST Overfill Prevention Device Test.docxdocx49675
DWM 4232 - UST Overfill Prevention Device Test.pdfpdf138742
DWM 4233 - UST Rectifier Operational Record for Impressed Current Cathodic Protection Systems.docxdocx50339
DWM 4233 - UST Rectifier Operational Record for Impressed Current Cathodic Protection Systems.pdfpdf124663
DWM 4234 - UST System Compatibility Verification.docxdocx64740
DWM 4234 - UST System Compatibility Verification.pdfpdf173656
DWM 4235 - UST Tank Tightness Test.docxdocx54997
DWM 4235 - UST Tank Tightness Test.pdfpdf143437
DWM 4236 - UST Visual Interstitial Log.docxdocx49065
DWM 4236 - UST Visual Interstitial Log.pdfpdf134955
DWM 4260 - UST Certification of Properly Cleaned USTs.docxdocx44424
DWM 4260 - UST Certification of Properly Cleaned USTs.pdfpdf116229
DWM 4261 - UST Classification Guide.docxdocx63071
DWM 4261 - UST Classification Guide.pdfpdf164184
DWM 4262 - UST Closure Assessment Report Checklist.docxdocx81733
DWM 4262 - UST Closure Assessment Report Checklist.pdfpdf204070
DWM 4263 - UST Corrective Action Certification.docxdocx50569
DWM 4263 - UST Corrective Action Certification.pdfpdf120753
DWM 4264 - UST Groundwater Monitoring Checklist.docxdocx57963
DWM 4264 - UST Groundwater Monitoring Checklist.pdfpdf152985
DWM 4265 - UST Interim Corrective Action Checklist.docxdocx59955
DWM 4265 - UST Interim Corrective Action Checklist.pdfpdf157056
DWM 4266 - UST Notice of Intent to Permanently Close Underground Storage Tank or Piping.docxdocx46570
DWM 4266 - UST Notice of Intent to Permanently Close Underground Storage Tank or Piping.pdfpdf126818
DWM 4267 - UST Over-Excavation Checklist.docxdocx59868
DWM 4267 - UST Over-Excavation Checklist.pdfpdf156973
DWM 4268 - UST Site Check Checklist.docxdocx60499
DWM 4268 - UST Site Check Checklist.pdfpdf161379
DWM 4269 - UST Site Investigation Checklist.docxdocx63857
DWM 4269 - UST Site Investigation Checklist.pdfpdf166897
DWM 4270 - UST Vapor Intrusion Assessment Checklist.docxdocx65422
DWM 4270 - UST Vapor Intrusion Assessment Checklist.pdfpdf192539
DWM 4271 - UST Vapor Intrusion Building Assessment Checklist.docxdocx64053
DWM 4271 - UST Vapor Intrusion Building Assessment Checklist.pdfpdf172511
DWM 4280 - UST Affidavit of Termination of PSTEAF Contract.docxdocx53733
DWM 4280 - UST Affidavit of Termination of PSTEAF Contract.pdfpdf139291
DWM 4281 - UST Affidavit of Waiver for PSTEAF Reimbursement.docxdocx49392
DWM 4281 - UST Affidavit of Waiver for PSTEAF Reimbursement.pdfpdf120486
DWM 4282 - UST Application for Assistance for PSTEAF.docxdocx65258
DWM 4282 - UST Application for Assistance for PSTEAF.pdfpdf213642
DWM 4284 - UST Application for PSTEAF Eligible Companies or Partnerships.docxdocx67019
DWM 4284 - UST Application for PSTEAF Eligible Companies or Partnerships.pdfpdf187989
DWM 4285 - UST Claim Request for Actions Not Directed.docxdocx55252
DWM 4285 - UST Claim Request for Actions Not Directed.pdfpdf153382
DWM 4286 - UST Claim Request for Directed Actions.pdfpdf402997
DWM 4286 - UST Claim Request for Directed Actions.xlsxxlsx75764
DWM 4289 - UST Payment Waiver.docxdocx56263
DWM 4289 - UST Payment Waiver.pdfpdf153867
DWM 4290 - UST Reconsideration Request.docxdocx48420
DWM 4290 - UST Reconsideration Request.pdfpdf139753
DWM 4292 - UST Third-Party Claim.docxdocx53296
DWM 4292 - UST Third-Party Claim.pdfpdf179017
DWM 4293 - UST Application for Assistance for SOTRA.docxdocx58173
DWM 4293 - UST Application for Assistance for SOTRA.pdfpdf189396
2019 Manuals
DownloadTypeFile Size
42-060 UST Corrective Action Manual.pdfpdf1696730
42-020 UST System Compliance Manual.pdfpdf626848
Kentucky Energy and Environment Cabinet
300 Sower Blvd
Frankfort, KY 40601    

Phone Directory
Contact Us
Civil Rights/Derecho Civiles

The Kentucky Energy and Environment Cabinet does not discriminate against any person on the basis of race, color, national origin, religion, age, disability or sex. This policy protects the rights of Cabinet employees, service applicants and customers. Vendors, agencies and organizations providing services to the Cabinet or its recipients of federally-aided programs also must comply with this policy.

© 2022 Commonwealth of Kentucky. All rights reserved.Kentucky.gov