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Kentucky Energy and Environment Cabinet
Underground Storage Tank Branch

​2019 Regulatory Amendments

Effective April 5, 2019

2019 Forms
DownloadTypeFile Size
DWM 4220 - UST Annual Walkthrough Inspection.docdoc215040
DWM 4220 - UST Annual Walkthrough Inspection.pdfpdf69246
DWM 4221 - UST Automatic Line Leak Detector Operational Test.docdoc250368
DWM 4221 - UST Automatic Line Leak Detector Operational Test.pdfpdf135017
DWM 4222 - UST Containment Device Test.docdoc162816
DWM 4222 - UST Containment Device Test.pdfpdf39316
DWM 4223 - UST Electronic Release Detection Equipment Test.docdoc200192
DWM 4223 - UST Electronic Release Detection Equipment Test.pdfpdf52832
DWM 4224 - UST Facility Owner Address Correction.docdoc101376
DWM 4224 - UST Facility Owner Address Correction.pdfpdf39237
DWM 4225 - UST Facility Registration.docdoc326144
DWM 4225 - UST Facility Registration.pdfpdf367698
DWM 4226 - UST Galvanic Cathodic Protection Evaluation.docdoc336896
DWM 4226 - UST Galvanic Cathodic Protection Evaluation.pdfpdf110294
DWM 4227 - UST Impressed Current Cathodic Protection Evaluation.docdoc327680
DWM 4227 - UST Impressed Current Cathodic Protection Evaluation.pdfpdf145428
DWM 4228 - UST Integrity Assessment.docdoc158208
DWM 4228 - UST Integrity Assessment.pdfpdf41313
DWM 4229 - UST Line Tightness Test.docdoc203776
DWM 4229 - UST Line Tightness Test.pdfpdf54167
DWM 4230 - UST Monthly Walkthrough Inspection.docdoc327680
DWM 4230 - UST Monthly Walkthrough Inspection.pdfpdf92630
DWM 4231 - UST Notice of Intent to Install Underground Storage Tank or Piping.docdoc107008
DWM 4231 - UST Notice of Intent to Install Underground Storage Tank or Piping.pdfpdf28622
DWM 4232 - UST Overfill Prevention Device Test.docdoc144384
DWM 4232 - UST Overfill Prevention Device Test.pdfpdf41691
DWM 4233 - UST Rectifier Operational Record for Impressed Current Cathodic Protection Systems.docdoc183808
DWM 4233 - UST Rectifier Operational Record for Impressed Current Cathodic Protection Systems.pdfpdf35323
DWM 4234 - UST System Compatibility Verification.docdoc272896
DWM 4234 - UST System Compatibility Verification.pdfpdf69945
DWM 4235 - UST Tank Tightness Test.docdoc198144
DWM 4235 - UST Tank Tightness Test.pdfpdf45591
DWM 4236 - UST Visual Interstitial Log.docdoc169472
DWM 4236 - UST Visual Interstitial Log.pdfpdf32385
DWM 4260 - UST Certification of Properly Cleaned USTs.docdoc96768
DWM 4260 - UST Certification of Properly Cleaned USTs.pdfpdf23797
DWM 4261 - UST Classification Guide.docdoc192000
DWM 4261 - UST Classification Guide.pdfpdf69468
DWM 4262 - UST Closure Assessment Report Checklist.docdoc390144
DWM 4262 - UST Closure Assessment Report Checklist.pdfpdf106268
DWM 4263 - UST Corrective Action Certification.docdoc115712
DWM 4263 - UST Corrective Action Certification.pdfpdf27117
DWM 4264 - UST Groundwater Monitoring Checklist.docdoc186880
DWM 4264 - UST Groundwater Monitoring Checklist.pdfpdf53823
DWM 4265 - UST Interim Corrective Action Checklist.docdoc205824
DWM 4265 - UST Interim Corrective Action Checklist.pdfpdf58373
DWM 4266 - UST Notice of Intent to Permanently Close Underground Storage Tank or Piping.docdoc108032
DWM 4266 - UST Notice of Intent to Permanently Close Underground Storage Tank or Piping.pdfpdf29102
DWM 4267 - UST Over-Excavation Checklist.docdoc205824
DWM 4267 - UST Over-Excavation Checklist.pdfpdf57063
DWM 4268 - UST Site Check Checklist.docdoc218624
DWM 4268 - UST Site Check Checklist.pdfpdf62488
DWM 4269 - UST Site Investigation Checklist.docdoc236032
DWM 4269 - UST Site Investigation Checklist.pdfpdf67589
DWM 4270 - UST Vapor Intrusion Assessment Checklist.docdoc246272
DWM 4270 - UST Vapor Intrusion Assessment Checklist.pdfpdf77794
DWM 4271 - UST Vapor Intrusion Building Assessment Checklist.docdoc223232
DWM 4271 - UST Vapor Intrusion Building Assessment Checklist.pdfpdf72183
DWM 4280 - UST Affidavit of Termination of PSTEAF Contract.docdoc112128
DWM 4280 - UST Affidavit of Termination of PSTEAF Contract.pdfpdf39108
DWM 4281 - UST Affidavit of Waiver for PSTEAF Reimbursement.docdoc100864
DWM 4281 - UST Affidavit of Waiver for PSTEAF Reimbursement.pdfpdf25325
DWM 4282 - UST Application for Assistance for PSTEAF.docdoc204288
DWM 4282 - UST Application for Assistance for PSTEAF.pdfpdf76148
DWM 4283 - UST Application for Laboratory Certification.docdoc130048
DWM 4283 - UST Application for Laboratory Certification.pdfpdf40966
DWM 4284 - UST Application for PSTEAF Eligible Company or Partnership.docdoc283136
DWM 4284 - UST Application for PSTEAF Eligible Company or Partnership.pdfpdf88159
DWM 4285 - UST Claim Request for Actions Not Directed.docdoc151552
DWM 4285 - UST Claim Request for Actions Not Directed.pdfpdf51847
DWM 4286 - UST Claim Request for Directed Actions.pdfpdf45722
DWM 4286 - UST Claim Request for Directed Actions.xlsxxlsx73273
DWM 4287 - UST Miscellaneous Tasks Reimbursement Worksheet.pdfpdf58535
DWM 4287 - UST Miscellaneous Tasks Reimbursement Worksheet.xlsxxlsx88036
DWM 4288 - UST Optional Soil Removal at Permanent Cl.xlsxxlsx97139
DWM 4288 - UST Optional Soil Removal at Permanent Closure Reimbursement Worksheet.pdfpdf58448
DWM 4289 - UST Payment Waiver.docdoc126464
DWM 4289 - UST Payment Waiver.pdfpdf51893
DWM 4290 - UST Reconsideration Request.docdoc107520
DWM 4290 - UST Reconsideration Request.pdfpdf38027
DWM 4291 - UST Re-Evaluation of a Reimbursable Amount.docdoc125440
DWM 4291 - UST Re-Evaluation of a Reimbursable Amount.pdfpdf50264
DWM 4292 - UST Third-Party Claim.docdoc138240
DWM 4292 - UST Third-Party Claim.pdfpdf50005
DWM 4293 - UST Application for Assistance for SOTRA.docdoc178176
DWM 4293 - UST Application for Assistance for SOTRA.pdfpdf66172
Kentucky Energy and Environment Cabinet
300 Sower Blvd
Frankfort, KY 40601

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