[
52719
]
EE-01 EE/RE Set Aside NOx Allowance Application
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
The purpose of this form is to obtain detailed information about the energy efficiency or renewable energy projects to calculate NOx allowance reservations.
[
52720
]
EE-02 Ozone Control Period Notification of Results
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
The purpose of this form is to obtain detailed information about actual electricity and other energy savings or electricity generation that occurred during the ozone season.
[
52721
]
EE-03 EE/RE Set Aside Nox Allowance Reapplication
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
The purpose of this form is to allow project sponsors to reapply for NOx allowances after an Initial NOx Allowance Application has been approved.
[
53902
]
Voluntary Idling Pledge
[
PDF
]
Program:
Air Quality - Programs
This form is used notify the Southwest Regional Office that you are establishing a voluntary idling program.
[
50639
]
Air Permit Application Cover Sheet
[
DOC
]
Program:
Air Quality - Permits
Cover sheet to obtain the core information needed to process the air permit application
[
51607
]
Air Permit Application Form Checklist
[
DOC
]
Program:
Air Quality - Permits
Checklist to help the applicant and IDEM, OAQ to ensure that the air permit application packet is administratively complete.
[
50640
]
GSD-01 General Source Data - Basic Source Level Information
[
DOC
]
Program:
Air Quality - Permits
Form to provide essential information about the entire source of air pollutant emissions.
[
51605
]
GSD-02 General Source Data - Plant Layout Diagram
[
DOC
]
Program:
Air Quality - Permits
Form to provide a diagram of the entire plant site.
[
51606
]
GSD-04 General Source Data - Stack / Vent Information
[
DOC
]
Program:
Air Quality - Permits
Form to provide basic information about each stack or vent that has the potential to emit air pollutants.
[
51610
]
GSD-05 General Source Data - Emissions Unit Information
[
DOC
]
Program:
Air Quality - Permits
Form to provide basic information about each emissions unit that has the potential to emit air pollutants.
[
51612
]
GSD-06 General Source Data - Particulate Emissions
[
DOC
]
Program:
Air Quality - Permits
This form is to provide basic information about each source of particulate emissions.
[
51602
]
GSD-07 General Source Data - Criteria Pollutant Emissions Summary
[
DOC
]
Program:
Air Quality - Permits
This form is to provide the actual and potential emissions of each criteria pollutant emitted from the source.
[
51604
]
GSD-08 General Source Data - Hazardous Air Pollutant Emissions Summary
[
DOC
]
Program:
Air Quality - Permits
This form is to provide the actual and potential emissions of each hazardous air pollutant emitted from the source.
[
51611
]
GSD-09 General Source Data - Summary of Additional Information
[
DOC
]
Program:
Air Quality - Permits
This form is used to supply a format for providing additional information about a process or emissions unit.
[
51596
]
GSD-10 General Source Data - Insignificant Activity
[
DOC
]
Program:
Air Quality - Permits
This form is to identify all trivial and insignificant activities in operation at the source.
[
51601
]
GSD-11 General Source Data - Alternative Operating Scenario Summary
[
DOC
]
Program:
Air Quality - Permits
This form is to identify and summarize any AOS that you are submitting with your air permit application.
[
51600
]
GSD-12 General Source Data - Affidavit of Non-applicability
[
DOC
]
Program:
Air Quality - Permits
This document is to certify that the requirement to notify adjacent landowners and occupants is not applicable to the source of air pollutant emissions.
[
51603
]
GSD-13 General Source Data - Affidavit of Applicability
[
DOC
]
Program:
Air Quality - Permits
This document is to certify that the requirement to notify adjacent landowners and occupants is applicable to the source of air pollutant emissions.
[
51609
]
GSD-14 General Source Data - Owners and Occupants Notified
[
DOC
]
Program:
Air Quality - Permits
The purpose of this document is to identify adjacent landowners and occupants that are to be notified that an air permit application has been submitted
[
51608
]
GSD-15 General Source Data - Government Officials Notified
[
DOC
]
Program:
Air Quality - Permits
This document is to identify local government officials that are to be notified that an air permit applicant has been submitted.
[
51755
]
Air Permit Application - Renewal Checklist
[
DOC
]
Program:
Air Quality - Permits
This checklist is to provide a worksheet for quickly assessing whether the air permit renewal application includes all necessary information.
[
51860
]
AEF-01 Alternative Emissions Factor Request
[
DOC
]
Program:
Air Quality - Permits
The purpose of this application is to request an alternate emission factor for permitting determinations, estimating source emissions for billing, or for development of emission inventories for use in air quality planning.
[
52534
]
PI-01 Miscellaneous Processes
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the process.
[
52535
]
PI-02A Combustion Unit Summary
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to summarize all of the combustion process units.
[
52536
]
PI-02B Combustion: Boilers, Process Heaters, & Furnaces
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to specify details that pertain only to boilers, process heaters and furnaces.
[
52537
]
PI-02C Combustion: Turbines & Internal Combustion Engines
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to specify details that pertain only to turbines and internal combustion engines.
[
52538
]
PI-02D Combustion: Incinerators & Combustors
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to specify details only to incinerators and combustors.
[
52539
]
PI-02E Combustion: Kilns
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to specify details that pertain only to kilns.
[
52540
]
PI-02F Combustion: Fuel Use
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify each fuel that will be used in the combustion unit.
[
52541
]
PI-02G Combustion: Emission Factors
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to specify the emission factors used to calculate potential to emit from the combustion unit.
[
52542
]
PI-02H Combustion: Federal Rule Applicability
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify any federal rules that apply to the emission unit.
[
52543
]
PI-03 Storage and Handling of Bulk Material
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the storage and handling of bulk materials.
[
52544
]
PI-04 Asphalt Plants
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the hot or cold asphalt production process.
[
52545
]
PI-05 Brick / Clay Products
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the brick and clay products manufacturing process.
[
52546
]
PI-06 Electroplating Operations
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the electroplating process.
[
52547
]
PI-07 Welding Operations
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the welding and cutting of metal.
[
52548
]
PI-08 Concrete Batchers
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about concrete batch processes.
[
52549
]
PI-09 Degreasing
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the degreasing process.
[
52550
]
PI-10 Dry Cleaners
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about dry cleaning operations.
[
52551
]
PI-11 Foundry, Smelting, and Die Cast Operations
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about foundry, smelting, and die cast operations.
[
52552
]
PI-12 Grain Elevators
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the grain elevator process.
[
52553
]
PI-13 Lime Manufacturing
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the lime manufacturing process.
[
52554
]
PI-14 Volatile Organic Liquid Compound Storage
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about all tanks larger than 250 gallons that are used to store volatile organic liquid compounds.
[
52555
]
PI-14 ALT Alternate Version of Volatile Organic Liquid Compound Storage
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about all tanks larger than 250 gallons that are used to store volatile organic liquid compounds.
[
52556
]
PI-15 Portland Cement Manufacturing
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the Portland cement manufacturing processes.
[
52557
]
PI-16 Reinforced Plastics & Composites
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the reinforced plastics and composites processes.
[
52558
]
PI-17 Blasting Operations
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the blasting process.
[
52559
]
PI-18 Mineral Processing
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about mineral processes such as sand and gravel processes, stone quarries, stone processing plants, and slag and kish handling plants.
[
52560
]
PI-19 Surface Coating & Printing Operations
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the surface coating and printing processes.
[
52561
]
PI-20 Woodworking / Plastic Machining
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the woodworking or plastic machining process.
[
52570
]
PI-21 On-site Soil Remediation
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the site remeditation process.
[
51904
]
CE-01 Control Equipment Summary
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to summarize all of the equipment used to control emissions.
[
51953
]
CE-02 Particulate Control Equipment Baghouse or Fabric Filter
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the parameters that describe the baghouse or fabric filter.
[
52620
]
CE-03 Particulate Control - Cyclone
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all the parameters that describe the cyclone.
[
52621
]
CE-04 Particulate Control - Electrostatic Precipitator
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all the parameters that describe the electrostatic precipitator.
[
52622
]
CE-05 Particulate Control - Wet Collector / Scrubber / Absorber
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all the parameters that describe the wet collector, scrubber, or absorption unit.
[
52623
]
CE-06 Organics - Flare / Oxidizer / Incinerator
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all the parameters that describe the oxidizer or incinerator.
[
52624
]
CE-07 Organics - Absorbers
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all the parameters that describe the adsorber.
[
52625
]
CE-08 Organics - Condenser
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all the parameters that describe the condenser.
[
52626
]
CE-09 Nitrogen Oxides Reduction Technology
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the parameters that describe the nitrogen oxide (Nox) reduction technology.
[
52436
]
CE-10 Miscellaneous Control Equipment
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the parameters that describe the control device.
[
51861
]
CD-01 Emissions Unit Compliance Status
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify the requirements that apply to each emissions unit at the permitted source and to determine the compliance status of these emissions units.
[
51862
]
CD-02 Compliance Plan Requirements Per Applicable Requirement
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify existing compliance monitoring activities (monitoring, testing, record keeping and/or reporting) required in an applicable requirement or to provide compliance monitoring activities for appliable requirements where there is no or inadequate compliance monitoring requirements.
[
51863
]
CD-03 Compliance Plan Requirements Per Emissions Unit
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify existing compliance monitoring activities (monitoring, testing, record keeping and/or reporting) required in an applicable requirement or to provide compliance monitoring activities for appliable requirements where there is no or inadequate compliance monitoring requirements.
[
51864
]
CD-04 Compliance Schedule and Certification
[
DOC
]
Program:
Air Quality - Permits
The purpose of this forms to provide a schedule for compliance certification submittals, a certification of the source's compliance status with all applicable requirements, and a compliance schedule that details the measures a source will use to address non-compliance
[
52451
]
PAL-01: Actuals Plantwide Applicability Limit
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to request a plantwide applicability limit (PAL) based on actual emissions.
[
52452
]
PAL-02: Revised Plantwide Applicability Limit
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to request a revision to an established plantwide applicability limit (PAL)
[
52453
]
PAL-03: Plantwide Applicability Limit Renewal
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to renew an established plantwide applicability limit (PAL)
[
52454
]
PAL-04: Request for Termination of Plantwide Applicability Limit
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to request termination or revocation of an established plantwide applicability limit (PAL)
[
53438
]
OA-01 Summary of Application and Existing Agreements
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to specify the individual operating agreements included with this application and to identify all existing operating agreements.
[
53439
]
OA-02 Industrial / Commercial Surface Coating Operations -OR- Graphic Arts Operations (326 IAC 2-9-2.5)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-9-2.5.
[
53440
]
OA-03 Surface Coating or Graphic Arts Operations (326 IAC 2-9-3)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-9-3.
[
53441
]
OA-04 Woodworking Operations (326 IAC 2-9-4)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-9-4.
[
53442
]
OA-05 Abrasive Cleaning Operations (326 IAC 2-9-5)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-9-5.
[
53443
]
OA-06 Grain Elevators (326 IAC 2-9-6)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-9-6.
[
53444
]
OA-07 Sand And Gravel Plants (326 IAC 2-9-7)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-9-7.
[
53445
]
OA-08 Crushed Stone Processing Plants (326 IAC 2-9-8)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-9-8.
[
53446
]
OA-09 Ready-Mix Concrete Batch Plants (326 IAC 2-9-9)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-9-9.
[
53447
]
OA-10 Coal Mines And Coal Preparation Plants (326 IAC 2-9-10)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-9-10.
[
53448
]
OA-11 Automobile Refinishing Operations (326 IAC 2-9-11)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-11.
[
53449
]
OA-12 Degreasing Operations (326 IAC 2-9-12)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-12.
[
53450
]
OA-13 External Combustion Sources (326 IAC 2-9-13)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-13.
[
53451
]
OA-14 Internal Combustion Sources (326 IAC 2-9-14)
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to identify all of the source specific operating agreement requirements for 326 IAC 2-14.
[
48625
]
Drycleaner Notification Form
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form satisfies the notification requirements of 40 CFR 63.324 (a), (b) and (c) and 326 IAC 20-7.
[
53430
]
Drycleaner Notification of Compliance Status
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form satisfies the notification requirements of 40 CFR 63.324 (f).
[
51956
]
Initial Notification Report Under Regulation 40 CFR Part 63, Subpart DDDDD
[
PDF
]
Program:
Air Quality - Compliance and Enforcement
The form is an example notification to satisfy the requirements of 40 CFR 63, Subpart DDDDD and 40 CFR 63.9(b).
[
53597
]
Outdoor Hydronic Heater Dealer Notice to Buyers
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
Documents requirement for Sellers to provide a copy of 326 IAC 4-3 to Outdoor Hydronic Heater Buyers and may be used by Sellers to provide notice to IDEM within seven (7) days of delivering a unit to a Buyer as required by the rule.
[
52571
]
Application Checksheet for Asbestos Contractor
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is to be used as a guide when applying for an asbestos contractor license.
[
52575
]
Application for Asbestos Contractor License
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is to be submit when applying for an Indiana Asbestos Contractor License.
[
48741
]
Application for Asbestos Training Course - Provider Approval
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is used to apply for an initial or renew an EPA approved Asbestos Training Course Provider certification.
[
48740
]
Application for Duplicate Asbestos License
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is used to replace an individual asbestos license.
[
43786
]
Application for Individual Asbestos License
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is used to apply for an initial or renew individual asbestos license.
[
44593
]
Notification of Demolition and Renovation Operations
[
PDF
]
Program:
Air Quality - Compliance and Enforcement
The form is used by property owners and contractors when demolishing or renovating a structure
[
49635
]
Identification of Potentially Affected Persons
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form satisfies the notification requirements of 40 CFR 63.324 (a), (b) and (c)
[
54801
]
Notification of Exempt Live Fire Training Under 326 IAC 4-1
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is a notification of open burning by municipal fire departments for fire training noted as exempt under 326 IAC 4-1-3(c)(9).
[
43688
]
Request for Use of an Air Curtain Open Pit Destructor
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is an application for an open burning approval to use an air curtain open pit destructor to comply with 326 IAC 4-1.
[
49634
]
Request for Fire Training Approval Under 326 IAC 4-1 - Acquired Structure
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is an application for an open burning approval for fire training to comply with 326 IAC 4-1.
[
50337
]
Request for Fire Training Approval Under 326 IAC 4-1 - Motor Vehicle
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is an application for an open burning approval for fire training using motor vehicles to comply with 326 IAC 4-1.
[
43692
]
Request for Tree or Clean Wood Waste Burn Approval Under 326 IAC 4-1
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is an application for an open burning approval for tree waste or clean wood waste to comply with 326 IAC 4-1.
[
55003
]
Compliance Test Protocol Form
[
PDF
]
Program:
Air Quality - Compliance and Enforcement
The form is a notification to satisfy the requirements of 326 IAC 3-6-2(a) for stack testing.
[
55059
]
RATA Notification Protocol Form
[
PDF
]
Program:
Air Quality - Compliance and Enforcement
The form is a notification to satisfy the requirements of 326 IAC 3-6-2(a) for all Relative accuracy Test Audit testing.
[
55058
]
VOCs & Toxics Compliance Test Protocol Form
[
PDF
]
Program:
Air Quality - Compliance and Enforcement
The form is a notification to satisfy the requirements of 326 IAC 3-6-2(a) for all VOC, Toxics, and HAP stack testing.
[
52052
]
AES-01 Air Emission Statement Certification
[
PDF
]
[
DOC
]
Program:
Air Quality - Programs
The purpose of the form is for certification of an air emission statement as well as any modifications submitted to comply with 326 IAC 2-6 (Emission Reporting).
[
52057
]
AES-06 Voluntary Hazardous Air Pollutant Reporting
[
PDF
]
[
DOC
]
Program:
Air Quality - Programs
The purpose of the form is for voluntary reporting hazardous air pollutant emissions for an air emission statement.
[
55543
]
Request for Fire Training Approval Under 326 IAC 4-1 – Stationary Facility
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance
Form used for fire training approvals.
[
50864
]
Request for Prescribed Vegetation Burn Approval Under 326 IAC 4-1
[
PDF
]
[
DOC
]
Program:
Air Quality - Compliance and Enforcement
This form is an application for a prescribed vegetation open burning approval to comply with 326 IAC 4-1.
[
51599
]
GSD-03 General Source Data - Process Flow Diagram
[
PDF
]
[
DOC
]
Program:
Air Quality - Permits
Document to provide a checklist for identifying the information on each Process Flow diagram.
[
51783
]
EC-01 Emission Credit Registry - Generation of Emission Credits
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to provide information regarding the generation of emission credits.
[
51784
]
EC-02 Emission Credit Registry - Transfer of Emission Credits
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to provide information regarding the transfer of emission credits.
[
51785
]
EC-03 Emission Credit Registry - Use of Emission Credits
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to provide information regarding the use of emission credits.
[
51906
]
EC-04 Emission Credit Registry - Emission Credits Request
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to provide a standardization method for submitting requests to post a company's emission credits wish list on the IDEM website.
[
53512
]
FED-01 - Summary of Federal Requirements - NSPS & NESHAP
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to provide a standardized way for sources to identify the NSPS or NESHAP requirements that are applicable to the regulated source.
[
51905
]
FED-02 MACT Pre-Construction Review
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to provide a standardized way for sources to request MACT preconstruction approval per 40 CFR 63.5.
[
53377
]
FED-03 Compliance Assurance Monitoring
[
DOC
]
Program:
Air Quality - Permits
The purpose of this form is to obtain detailed information about the monitoring protocol that is proposed to satisfy the federal requirements for compliance assurance monitoring (CAM) under 40 CFR Part 64.
[
52053
]
AES-02 General Facility Information
[
PDF
]
[
DOC
]
Program:
Air Quality - Programs
The purpose of the form is to provide general facility information for an air emission statement submitted to comply with 326 IAC 2-6 (Emission Reporting).
[
52054
]
AES-03 Stack Information
[
PDF
]
[
DOC
]
Program:
Air Quality - Programs
The purpose of the form is to provide stack information for an air emission statement submitted to comply with 326 IAC 2-6 (Emission Reporting).
[
52055
]
AES-04 Abatement Equipment
[
PDF
]
[
DOC
]
Program:
Air Quality - Programs
The purpose of the form is to provide abatement (control) equipment information for an air emission statement submitted to comply with 326 IAC 2-6 (Emission Reporting).
[
52056
]
AES-05 Group/Process/Emissions Information
[
PDF
]
[
DOC
]
Program:
Air Quality - Programs
The purpose of the form is to provide information about groups, processes, and process emissions for an air emission statement submitted to comply with 326 IAC 2-6 (Emission Reporting).
[
-----
]
Air Toxics - U.S. EPA: Initial Notification
[
DOC
]
Program:
Air Quality - Permits
THIS IS A SAMPLE NOTIFICATION FORM, WHICH CAN BE USED BY FACILITIES AT THEIR DISCRETION TO MEET COMPLIANCE WITH 40 CFR 63 Subpart A, 63.9(b)
[
47551
]
Automated Direct Deposit Authorization Agreement
[
PDF
]
[
53788
]
Vendor Information
[
PDF
]
[
50014
]
IDEM Complaint Form
[
PDF
]
Program:
Chief of Staff - Media and Communications
This form is used to submit information on environmental pollution to IDEM.
[
53088
]
Solid Waste Land Disposal Facilities Renewal Application Checklist
[
PDF
]
[
DOC
]
Program:
Chief of Staff - SW Permits
Checklist provided to Solid Waste Disposal Facilities for assurance all documentation is included in renewal applications.
[
57061
]
Report a Complaint Online
[
WEBFORM
]
To obtain complaints electronically.
[
57060
]
IDEM Questions / Comments
[
WEBFORM
]
To obtain questions for the Indiana Department of Environmental Management (IDEM) Electronically.
[
57327
]
Remediation/Progress Monitoring (R/PM) Cover Sheet and Report Format
[
PDF
]
Program:
Chief of Staff - VRP
[
51778
]
Indiana Economic Impact - Proposals and Contracts
[
PDF
]
[
XLS
]
[
46270
]
Water Test Kit Order
[
PDF
]
[
18865
]
Statement for Deduction of Assessed Valuation
[
PDF
]
[
20094
]
Registration of a Significant Water Withdrawal Facility
[
PDF
]
[
51872
]
Adjacent Landowner/Occupant Affidavit
[
DOC
]
Program:
Land Quality - SW Permits
The form is used by the applicant to confirm they have notified adjacent landowners they have submitted an application for a new solid waste facility or a major solid waste facility expansion.
[
51910
]
Field Tile Monitoring At Land Application Sites (Personal Document)
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document monitoring of field tile outlets at manure application sites.
[
53765
]
Auto Salvage Recyclers Environmental Self-Audit Checklist
[
PDF
]
Program:
Land Quality - IW Compliance
This form is used to provide information about an auto salvage recycler facility.
[
55051
]
Complete CFO/CAFO Application Packet
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
Application packet to submit CFO, CAFO, and NPDES Individual Permits
[
55054
]
CFO Closure Certification
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
Certification on the closure of the waste storage structure
[
51255
]
CFO Construction Affidavit
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
Affidavit on meeting the requirements for construction of the confined feeding operation.
[
50210
]
CFO Construction Notification
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
To report any facility changes to the CFO operations as approved to IDEM in writing.
[
50209
]
CFO Facility Change Notification
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
To notify IDEM of a confined feeding operation facility change
[
49832
]
CFO Request for Approval Transfer
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
Form to document the transfer of CFO Approval to a new owner/operator within 90 days of the date of transfer
[
55162
]
CFO Request for Approval to Surface Apply Manure to Frozen or Snow-Covered Ground
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
Form for CFOs (not large CAFOs) with less than 120 days of approved storage capacity to request authorization to surface apply manure to frozen or snow-covered ground.
[
49827
]
CFO Request for Exiting the Program
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
Form used to exit the CFO program.
[
55053
]
Professional Engineer Certification Construction of Concrete Liquid Manure Storage Structures
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form used by CFO to document the construction of concrete liquid manure storage structures by a professional engineer.
[
55052
]
Professional Engineer Certification Construction of Earthen Liquid Manure Storage Structures
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form used by CFO to document the construction of earthen liquid manure storage structures by a professional engineer.
[
55716
]
Professional Engineer Certification for Construction of Geomembrane Lined Liquid Manure Storage Structures
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form used by CFO to document the construction of geomembrane lined liquid manure storage structures by a professional engineer.
[
56029
]
CFO Marketing or Distribution of Manure Information Sheet
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document distribution information of manure ¿from a CFO.
[
52510
]
CAFO Annual Report
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used by a CAFO to document farm information annually.
[
51913
]
CAFO Closure of Manure, Litter, Process Wastewater Storage Structures
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document the closure of manure, litter, process wastewater storage structures according to CAFO rules.
[
55056
]
CAFO Construction Completion Affidavit
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used by a CAFO to document completion of approved construction.
[
51911
]
CAFO Construction Notification
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used by a CAFO to document the beginning of approved construction.
[
55055
]
CAFO Removal from NPDES CAFO Permit Program
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used by a CAFO to exit the NPDES CAFO Permit Program.
[
54138
]
Registration Form for Storage and Processing Facilities
[
PDF
]
Program:
Land Quality - HW Permits
This is the facility registration for electronic waste storage and processing facilities located in Indiana.
[
47214
]
Facility Permit Fee Transmittal
[
DOC
]
Program:
Land Quality - HW Permits
This form must be used to transmit fees for all hazardous waste management facility permit applications and modifications (NEW permits, RENEWAL of permits, Class 2 & 3 MODIFICATION of permits) pursuant to IC 13-22-12, and is to accompany all payments.
[
56082
]
Environmental Restrictive Covenant / Deed Notice Modification or Termination Request
[
PDF
]
[
DOC
]
Program:
Land Quality - Institutional Controls
This form is necessary for owners of ERC restricted properties to request a change in land use restrictions.
[
50405
]
Notification for the Construction of a Storage Structure for Biosolids/Industrial Waste Product or Pollutant-bearing Water
[
DOC
]
Program:
Land Quality - SW Permits
This form is to apply for approval to construct and operate a storage structure for the storage of biosolids, industrial waste products, or pollutant-bearing water at the land application site or generating facility. Structures meeting specific criteria may apply under the notification program. Life time permit, does not require renewal
[
50406
]
Permit Application for the Construction of a Storage Structure for Biosolids/Industrial Waste Product or Pollutant-Bearing Water
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for a permit to construct and operate a storage structure for the storage of biosolids, industrial waste products, or pollutant-bearing water at the land application site or generating facility. A permit is required if constructing an earthen lagoon and for structures/locations of structures that do not meet the specific criteria outlined in 327 IAC 6.1-8. Life time permit, does not require renewal
[
50407
]
Notification for the Land Application of Agricultural Lime Substitute
[
DOC
]
Program:
Land Quality - SW Permits
This is an application to operating under the notification program. Annual renewal
[
50408
]
Permit Application for the Marketing and/or Distribution of Biosolids
[
DOC
]
Program:
Land Quality - SW Permits
To apply for or renewal of a Marketing & Distribution permit under 327 IAC 6.1 for the beneficial use of Class A biosolids. Beneficial use includes using as a feedstock for composting, soil amendment, and/or has fertilizer value.
[
50409
]
Permit Application for the Land Application of Domestic Wastewater
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for or renewal of a land application permit to land apply Pollutant-bearing water and specifically treated domestic wastewater (human waste)
[
50410
]
Permit Application for the Land Application of Biosolids
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for or renewal of a Land Application Permit for the land application of biosolids
[
53514
]
Permit Application for the Marketing and/or Distribution of Industrial Waste Products
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for or renewal of a Marketing & Distribution permit under 327 IAC 6.1 for the beneficial use of industrial waste products. Beneficial use includes using as a feedstock for composting, soil amendment, and/or has fertilizer value
[
53517
]
Permit Application for the Land Application of Industrial Waste Products
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for or renewal of a Land Application Permit for the land application of industrial waste products
[
53558
]
Notification for the Land Application of Small Quantities of Pollutant-bearing Water
[
DOC
]
Program:
Land Quality - SW Permits
This is an application for or renewal to operate under the notification program
[
53584
]
Permit Application for the Land Application of Industrial Process Wastewater
[
DOC
]
Program:
Land Quality - SW Permits
This form is to apply for or renewal of a Land Application Permit for the land application industrial waste products
[
55308
]
Alternative Fuel Processor Registration Application
[
PDF
]
Program:
Land Quality - SW Permits
This is a registration form to use waste as an alternative fuel in a boiler, kiln, etc.
[
55309
]
Biomass Digester/Gasification Facility Registration Application
[
PDF
]
Program:
Land Quality - SW Permits or CFO Permits
This form is used to register a Biomass Digester/Gasification Facility as a stand alone or on an approved confined feeding operation.
[
53317
]
Insignificant Permit Modification Checklist Solid Waste Land Disposal Facilities
[
PDF
]
Program:
Land Quality - SW Permits
This form is used for determining if submitting everything needed for insignificant modification.
[
55307
]
Mobile Home Salvaging Facility Registration Application
[
PDF
]
Program:
Land Quality - SW Permits
This form is for the registration to dismantle mobile homes for reuse of the resulting appliances, lumber, etc.
[
50391
]
Municipal Solid Waste Landfill Closure Plan (329 IAC 10-22)
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to submit the closure plan for a municipal solid waste landfill.
[
50388
]
Municipal Solid Waste Landfill Post-Closure Plan (329 IAC 10-23)
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to submit the post-closure plan for a municipal solid waste landfill.
[
47215
]
Solid Waste Facility Permit Application & Registration Fee Transmittal
[
PDF
]
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to submit solid waste application fees.
[
50393
]
Solid Waste Facility Transfer Application
[
PDF
]
Program:
Land Quality - SW Permits
This form is used to apply for transfer of solid waste permits.
[
50404
]
Solid Waste Land Disposal Facility Permit Application
[
PDF
]
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for a new landfill permit or a major or minor modification of a landfill permit.
[
50386
]
Solid Waste Land Disposal Facility Permit Renewal Application
[
PDF
]
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for a renewal of a landfill permit.
[
53315
]
Solid Waste Processing Facilities and Incinerators / New Facility and Major Modification Permit Application Checklist
[
PDF
]
[
DOC
]
Program:
Land Quality - SW Permits
This form is a checklist of what needs to be submitted with an application for a new solid waste processing facility or a major modification of facility.
[
50392
]
Solid Waste Processing Facility Permit Application
[
PDF
]
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for a new solid waste processing facility ¿permit, or a major or minor modification of a solid waste processing facility permit.
[
50387
]
Solid Waste Processing Facility Permit Renewal Application
[
PDF
]
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for a renewal of a solid waste processing facility permit.
[
56424
]
ELTF Claims Application (Phase Approach)
[
XLS
]
Program:
Land Quality - UST Operations
ELTF claim submission for costs incurred on or after 1/1/2016.
[
47139
]
ELTF Claims Application
[
XLS
]
Program:
Land Quality - UST Operations
ELTF claim submission for costs incurred before 1/1/2018.
[
55459
]
ELTF Eligibility Application
[
PDF
]
Program:
Land Quality - UST Operations
Request ELTF eligibility determination for LUST incident.
[
51955
]
ELTF Scope of Work for Leaking UST Sites
[
XLS
]
Program:
Land Quality - UST Operations
Request preapproval for site characterization and corrective action costs for LUST incident.
[
56548
]
Initial Registration for Underground Storage Tank Systems
[
PDF
]
Program:
Land Quality - UST Operations
Register new UST facility.
[
45223
]
Notification for Underground Storage Tank Systems
[
PDF
]
Program:
Land Quality - UST Operations
Make amendments to UST facility data record.
[
56553
]
Thirty (30) Day Notification of Intent to Close
[
PDF
]
Program:
Land Quality - UST Operations
Notify of intent to close a UST.
[
56554
]
Underground Storage Tank Systems Closure Report
[
PDF
]
Program:
Land Quality - UST Operations
Report a closure of a UST.
[
47271
]
VRP Application and Instructions
[
PDF
]
[
DOC
]
Program:
Land Quality - VRP
This form is used to apply to the Voluntary Remediation Program
[
53413
]
VRP Remediation Work Plan Completeness Checklist
[
PDF
]
Program:
Land Quality - VRP
Checklist for submitting Remediation Work Plan to the Voluntary Remediation Program.
[
47221
]
Application for Waste Tire Processing Operation Registration (or Renewal)
[
PDF
]
Program:
Land Quality - SW Permits
This is a form to register for Waste Tire Processing.
[
47222
]
Application for Waste Tire Storage Site Registration (or Renewal)
[
PDF
]
Program:
Land Quality - SW Permits
This form is used to apply or renew as a Waste Tire Transporter
[
47220
]
Application for Waste Tire Transporter Registration (or Renewal)
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply or renew as a Waste Tire Storage Site
[
54817
]
Contingency Plan for Waste Tire Processing Operations and Storage Sites
[
PDF
]
Program:
Land Quality - SW Permits
This form describes the actions the operator will take to minimize hazards for files, contaminated run-off from fires, and mosquito breeding
[
47273
]
Waste Tire Manifest
[
PDF
]
Program:
Land Quality - SW Permits
This form is used to track the source or generator of waste tires and where they are shipped to.
[
55351
]
Waste Tire Facility Closure Notification
[
DOC
]
Program:
Land Quality - SW Permits
This form is to notify IDEM of the closure of a Waste Tire Facility.
[
50403
]
Application for a Wastewater (Septage) Management Land Application Site Permit
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for a Wastewater (Septage) Land Application Permit
[
50399
]
Application for Septage Management Business Permit
[
PDF
]
Program:
Land Quality - SW Permits
This form is used to apply for a Septage Management Business Permit
[
50397
]
Septage Land Application Quarterly Report
[
PDF
]
[
XLS
]
Program:
Land Quality - SW Permits
This form is used to track the gallons of septage land applied and verifies completion of lime treatment.
[
53238
]
Claim for Payment for Mercury Switches from End-of-life Vehicles (ELVs)
[
PDF
]
[
DOC
]
Program:
Land Quality - SW Auto
Use this form to request payment for mercury switches removed from end-of-life vehicles under IC 13-20-17.7
[
53924
]
Indiana Clean Yard Best Management Practices Checklist
[
DOC
]
Program:
Land Quality - SW Auto
Checklist for auto salvage yards to enter into the Indiana Clean Yard program-Gold-Level
[
53766
]
Indiana Clean Yard Certification Statement
[
PDF
]
Program:
Land Quality - SW Auto
This form is used to submit a certification statement to enter Indiana Clean Yard Program
[
-----
]
CFO Emergency Notification for Manure Application to Frozen or Snow-Covered Ground
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used to apply for and receive approval to apply manure to frozen or snow-covered ground in an emergency situation
[
-----
]
CFO Emergency Spill Response Documentation
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document the response to a manure spill from a CFO.
[
-----
]
CFO Emergency Spill Response Plan
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document the prepared response to a manure spill from a CFO.
[
-----
]
CFO Manure Application Record
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document manure application records for a CFO.
[
-----
]
CFO Manure Distribution Record
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document distribution information of manure ¿from a CFO.
[
-----
]
CFO Manure Land Usage Agreement
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document the agreement between a land owner and CFO operator to apply manure on specific acres.
[
-----
]
CFO Self-Inspection Records
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document self-inspection records of a CFO by the CFO operator.
[
-----
]
CFO Storm Water Management Certification
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document the CFO meets storm water management requirements from 327 IAC 19-11-2.
[
-----
]
CFO Storm Water Management Requirements for Concentrated Animal Feeding Operations
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document the CAFO meets the storm water record keeping requirements in 40 CFR 122.42(e)(2).
[
-----
]
Compliance Guide (Construction & Operation)
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document the CFO is in compliance with the CFO Approval.
[
-----
]
Solid Manure Staging Record
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This document is used to document solid manure staging information.
[
-----
]
2015 Self Inspection Sheet
[
XLS
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document CFO self inspection results.
[
-----
]
CAFO Emergency Spill Response Documentation
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document the response to a manure spill from a CAFO.
[
-----
]
CAFO Emergency Spill Response Plan
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document the prepared response plan to a manure spill from a CAFO.
[
-----
]
CAFO Land Usage Agreement
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document the agreement between a land owner and CAFO operator to apply manure on specific acres.
[
-----
]
CAFO Manure Application Record
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document manure application records for a CAFO.
[
-----
]
CAFO Manure Distribution Record
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document distribution information of manure ¿from a CAFO.
[
-----
]
CAFO Marketing or Distribution of Manure Information Sheet
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document distribution information of manure ¿from a CAFO.
[
-----
]
CAFO Precipitation Events at Land Application Sites
[
PDF
]
Program:
Land Quality - Confined Feeding Operations
This form is used to document precipitation events at manure land application sites.
[
52953
]
Waste Classification Application Checklist
[
PDF
]
Program:
Land Quality - Compliance
Used to track waste classifications
[
55715
]
Institutional Controls Self Audit Checklist
[
PDF
]
Program:
Land Quality - State Cleanup
Self Audit for those that are under the Institutional Controls program
[
52954
]
Legitimate Use Approval Application Checklist
[
PDF
]
Program:
Land Quality - Legitimate Use Approval
Form used as a checklist for legitimate use.
[
53082
]
Satellite Manure Storage Structure (SMSS) Request for Permit Transfer
[
PDF
]
For permit transfer requests of satellite manure storage structures
[
53084
]
Professional Engineer Certification for Construction of Geomembrane Lined Liquid Satellite Manure Storage Structures (SMSS)
[
PDF
]
Use this form to certify construction of a liquid manure storage structure.
[
53085
]
Satellite Manure Storage Structure SMSS Construction of Earthen Liquid Manure
[
PDF
]
To certify construction of a liquid manure storage structure.
[
53037
]
Satellite Manure Storage Structure (SMSS) Construction Notification
[
PDF
]
A notification for Satellite Manure Storage Structure (SMSS) construction
[
53081
]
Satellite Manure Storage Structure (SMSS) Facility Change Notification
[
PDF
]
A notification for Satellite Manure Storage Structure (SMSS) facility change
[
53079
]
Acknowledgement of Reliance Upon Ordinance to Control Access to Groundwater
[
PDF
]
Form for Acknowledgement of Reliance Ordinance to Control Access to Groundwater
[
53083
]
Satellite Manure Storage Structure (SMSS) Completed Construction Affidavit
[
PDF
]
Construction affidavit for Satellite Manure Storage Structures
[
53086
]
Satellite Manure Storage Structure (SMSS) Construction of Concrete Liquid Manure
[
PDF
]
To certify construction of a liquid manure storage structure.
[
57059
]
IDEM Dry Cleaner and Laundry (DCaL) Dataset
[
WEBFORM
]
[
57103
]
IDEM E-Submission Enrollment
[
WEBFORM
]
E-Submission Enrollment for various Office of Land Quality programs.
[
57234
]
Notice of Contamination in Right of Way
[
PDF
]
Program:
Land Quality - Institutional Controls
Provides notice that contaminated soil an/or groundwater is present in Right of Way because a release of contamination to the environment from an IDEM reported incident.
[
57241
]
Waste Tire Grant Program Application
[
PDF
]
[
DOC
]
To apply for waste tire grant.
[
57242
]
Waste Tire Grant Expenditure Report
[
PDF
]
[
DOC
]
To report expenses on waste tire grant.
[
53148
]
Application for Underground Storage Tank Certification
[
PDF
]
Program:
Land Quality - UST Operations
[
53150
]
Application for Renewal of Underground Storage Tank Certification
[
PDF
]
Program:
Land Quality - UST Operations
[
57108
]
Voluntary Remediation Program Annual Report
[
PDF
]
Program:
Land Quality - VRP
Form for VRP sites to document annual progress
[
57108
]
Voluntary Remediation Program Annual Report
[
PDF
]
Program:
Land Quality - VRP
Form for VRP sites to document annual progress
[
57335
]
Notification for Aboveground Storage Tank Systems
[
PDF
]
Program:
Land Quality - Petroleum Remediation
[
57385
]
Site Characterization Report Cover Sheet/Checklist
[
PDF
]
[
DOC
]
Program:
Land Quality - VRP
[
54168
]
VRP Remediation Completion Report Completeness Checklist
[
PDF
]
Program:
Land Quality - VRP
Checklist for submitting VRP Closure Report
[
57299
]
50% Reimbursement ELTF Eligibility Application for UST Decommissioning/Replacement
[
PDF
]
Program:
Land Quality - UST Operations
[
57322
]
50% Reimbursement ELTF Claims Application for UST Decommissioning/Replacement
[
XLS
]
Program:
Land Quality - UST Operations
[
-----
]
Post-Closure Permit Application Checklist
[
DOC
]
Program:
Land Quality - Hazardous Waste Permits
[
56088
]
LUST No Further Action Request Cover Sheet and Report Format
[
PDF
]
[
DOC
]
Program:
Land Quality - Petroleum Remediation
This form is intended to assist with the organization of No Further Action (NFA) Requests.
[
50400
]
Good Character Disclosure Statement
[
PDF
]
[
DOC
]
Program:
Land Quality - SW Permits
This form shall be used to submit the good character disclosure statement required by IC 13-19-4 for obtaining a solid waste facility permit or a hazardous waste treatment, storage, or disposal facility permit
[
52123
]
Transfer Facilities Notification
[
PDF
]
[
DOC
]
Program:
Land Quality - Regulatory Reporting
This form is used to provide IDEM with a notification of hazardous waste transfer facilities
[
-----
]
RCRA Part B Permit Application Checklist Comments
[
DOC
]
Program:
Land Quality - Hazardous Waste Permits
[
50402
]
Application for a Wastewater (Septage) Management Storage/Treatment Facility Permit
[
DOC
]
Program:
Land Quality - SW Permits
This form is used to apply for a Wastewater (Septage) Management Storage/Treatment Facility Permit
[
-----
]
RCRA Part B Permit Application Checklist
[
PDF
]
Program:
Land Quality - Hazardous Waste Permits
[
55439
]
LUST Initial Site Characterization (ISC) Report Cover Sheet & Report Format
[
PDF
]
[
DOC
]
Program:
Land Quality - Petroleum Remediation
This form is intended to assist with the organization of the Initial Site Characterization (ISC).
[
54487
]
LUST Initial Incident Report
[
PDF
]
[
DOC
]
Program:
Land Quality - Petroleum Remediation
This form is used to report all suspected and confirmed releases within twenty-four (24) hours of discovery
[
-----
]
Letter of Credit Suggested Language
[
DOC
]
Program:
Land Quality - Hazardous Waste Permits
[
50414
]
Yard Waste Composting Facility Registration Application
[
PDF
]
[
DOC
]
Program:
Land Quality - SW Permits
This form is for facilities subject to IC 13-20-10 that wishes to compost vegetative matter, such as leaves, grass, brush, limbs, and branches
[
56423
]
Satellite Manure Storage Structure (SMSS) Permit Application Packet
[
PDF
]
[
DOC
]
Program:
Land Quality - Confined Feeding Operations
This form is used to submit a Satellite Manure Storage Structures (SMSS) application under 327 IAC 20 and IC 13-18-10.5.
[
55440
]
LUST Initial Site Characterization (ISC) Checklist
[
PDF
]
[
DOC
]
Program:
Land Quality - Petroleum Remediation
This form is used to create consistency and to ensure the submittal of all information required by 329 IAC 9-5-5.1 for an Initial Site Characterization (ISC).
[
46244
]
Hazardous Waste Disposal Fee
[
PDF
]
[
DOC
]
Program:
Land Quality - Regulatory Reporting
This form is used to submit a hazardous waste disposal fee.
[
56723
]
Solid Waste Quarterly Fees
[
PDF
]
Program:
Land Quality - Regulatory Reporting
This form is to be filed each quarter by all permitted solid waste disposal facilities in Indiana.
[
56087
]
LUST Quarterly Monitoring Report (QMR) Cover Sheet and Report Format
[
PDF
]
[
DOC
]
Program:
Land Quality - Petroleum Remediation
This form is intended to assist with the organization of the Quarterly Monitoring Report (QMR).
[
52392
]
Used Oil Management Report
[
PDF
]
[
DOC
]
Program:
Land Quality - Regulatory Reporting
This form is used for oil processors or re-refiners to submit a usage report
[
-----
]
Surety Bond Suggested Language
[
DOC
]
Program:
Land Quality - Hazardous Waste Permits
[
-----
]
Post-Closure Permit Application Guidance
[
DOC
]
Program:
Land Quality - Hazardous Waste Permits
[
54166
]
Independent Closure Process - Site Closure
[
PDF
]
[
XLS
]
Program:
Land Quality - Petroleum Remediation
This form is used to notify IDEM of an Independent Closure Process completion
[
55441
]
LUST Further Site Investigation (FSI) Report Cover Sheet & Report Format
[
PDF
]
[
DOC
]
Program:
Land Quality - Petroleum Remediation
This form is intended to assist with the organization of the Further Site Investigation (FSI).
[
55542
]
Public Records Request Form
[
PDF
]
[
DOC
]
Program:
Legal Counsel - Office of Records Management
Use this form for a request for a public record
[
53116
]
CLEAN Community Challenge Annual Performance Report
[
PDF
]
[
DOC
]
Annual report for CLEAN members
[
51826
]
CLEAN Community Challenge Program Application
[
DOC
]
Communities use this form to apply to the CLEAN program
[
53582
]
Indiana Clean Marina Pledge
[
PDF
]
Used by marinas, boat yards, yacht clubs, etc. to pledge to use best environmental practices
[
53475
]
Environmental Stewardship Program Annual Performance Report
[
PDF
]
[
DOC
]
Members of the Environmental Stewardship Program use this form to report their annual performance results
[
53706
]
Environmental Stewardship Program Checklist for Potential Regulatory Incentives
[
PDF
]
[
DOC
]
Form used by ESP members to request regulatory incentives
[
56054
]
Partners for Pollution Prevention Application
[
PDF
]
[
DOC
]
Program:
OPS - Pollution Prevention
Form used to apply to become a member of the Partners for Pollution Prevention
[
53334
]
Indiana Pollution Prevention (P2) Grant Program Application
[
PDF
]
[
DOC
]
Program:
OPS - Pollution Prevention
Used by businesses, manufacturers, and industry to submit a grant request to the Pollution Prevention Grant Program
[
51986
]
Community Recycling Grant Expenditure Report
[
PDF
]
The form is used by Community Recycling Grant recipients to track expenditures and submit to the program for reimbursement.
[
56962
]
Community Recycling Grant Personnel Activity Report
[
PDF
]
The form is used by Community Recycling Grant recipients to track personnel time spent on the project as the recipient's in-kind match.
[
56957
]
Community Recycling Grant Program Final Report
[
PDF
]
[
DOC
]
The form is used by Community Recycling Grant recipients to submit a final report of the grant funded project.
[
54926
]
Recycling Market Development Grant Expenditure Report
[
PDF
]
The form is used by Recycling Market Development Grant recipients to track expenditures and submit to the program for reimbursement.
[
54922
]
Recycling Market Development Grant Final Report
[
PDF
]
The form is used by Recycling Market Development Grant recipients to submit a final report of the grant funded project.
[
54921
]
Recycling Market Development Grant Progress Report
[
PDF
]
The form is used by Recycling Market Development Grant recipients to submit a progress report of the grant funded project.
[
56936
]
Recycling Market Development Grant Proposal Cover Page
[
DOC
]
This form is used as a cover page by businesses, schools, not for profits, municipalities, and solid waste management districts while submitting a Recycling Market Development Program Grant Proposal.
[
55075
]
Self-Disclosure and Environmental Audit Application Form
[
PDF
]
[
DOC
]
This form is used by facilities reporting the findings of a self audit and wanting to dislose a violation to the agency.
[
52772
]
Environmental Stewardship Program Application
[
PDF
]
[
DOC
]
Form for facilities to apply to the Environmental Stewardship Program
[
53076
]
Central Indiana Waste Diversion Pilot Project Application
[
PDF
]
To collect applications to award grant money for the most practical and effective means of diverting recyclable materials from waste streams for commercial reuses.
[
53581
]
Indiana Clean Boater Pledge
[
PDF
]
[
DOC
]
[
WEBFORM
]
This form is used by recreational boaters to pledge to best environmental practices when boating
[
56138
]
Partners for Clean Air Annual Membership Pledge
[
WEBFORM
]
Membership pledge for Partners for Clean Air
[
55675
]
Partners for Clean Air: Annual Award Nomination
[
WEBFORM
]
Nomination form for Partners for Clean Air
[
53567
]
Indiana Clean Marina Program Application
[
XLS
]
Used by marinas, boat yards, yacht clubs etc. to apply for designation as a Clean Marina
[
56847
]
Community Recycling Grant Program Application Package
[
PDF
]
This form is used by SWMDs, counties, cities, non-profits, and schools to apply for funding for recycling projects through the Community Recycling Grant Program.
[
57371
]
Voluntary Remediation Investigation Plan Checklist
[
PDF
]
[
56875
]
Partners for Clean Air PCA Scholarship Application
[
DOC
]
Application PCA for a scholarship
[
56136
]
CLEAN Community Challenge New Applicant Pre-Application
[
DOC
]
Pre-application to the CLEAN program
[
57190
]
Environmental Stakeholder Request
[
WEBFORM
]
[
57196
]
Governor's Award for Environmental Excellence Nomination Form
[
DOC
]
To collect nomination submissions for the Governor's Award for environmental Excellence.
[
40248
]
Application for Indiana Salvage Motor Vehicle Business License
[
PDF
]
[
47551
]
Automated Direct Deposit Authorization Agreement
[
PDF
]
Request for Taxpayer Identification Number and Certification
[
-----
]
Application for Permit to Discharge Storm Water Discharges Associated with Industrial Activity, Form 2F NPDES
[
PDF
]
[
-----
]
CAIR Permit Application (Sources Covered Under the CAIR SIP) - Part 96
[
DOC
]
[
-----
]
Boiler MACT Initial Notification: National Emission Standards for Hazardous Air Pollutants (NESHAP) for Major Sources
[
PDF
]
[
-----
]
CAIR Permit Application (Sources Covered under the FIP) - Part 97
[
DOC
]
[
56955
]
Asbestos Monitoring Waiver Certification Statement
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
The purpose is for public water systems to verify if their system has any asbestos-cement pipe. If the public water systems contains asbestos-cement pipe the system may need to include a copy of a Langlier Index run along with the form to demonstrate if the water is non-corrosive.
[
55788
]
Backflow Device Test Form
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
The Backflow Prevention and Cross Connection Control Program establishes reasonable guidelines and regulations to ensure that public water systems develop an effective Cross Connection Control Program for their entire system. This program requires customers of public water systems to install backflow prevention devices as well as having these devices tested at a minimum of once a year as required in 327 IAC 8-10 [PDF]. These results should be reported on the ¿Backflow Device Test Form ¿ 55788¿ (available on the IDEM Forms page). The completed form must be submitted in the method required by the public water system to both customer and the public water system within 30 days of the test being completed. This form, nor any backflow test form, should not be sent to IDEM, unless specifically requested by IDEM.
[
49187
]
Determination of Groundwater Under the Direction of Influence of Surface Water
[
PDF
]
Program:
Water Quality - DW
This form helps IDEM to evaluate public water suppliers classified with groundwater sources to determine whether the groundwater is under the direct influence of surface water.
[
55623
]
CCR Electronic Delivery Certification - Drinking Water
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This form confirms if a community water system distributed its consumer confidence report to customers when using electronic delivery. It also certifies that the information contained in the consumer confidence report is correct.
[
54187
]
CCR Certification in Drinking Water
[
PDF
]
Program:
Water Quality - DW
This form confirms if a community water system distributed its consumer confidence report to customers. It also certifies that the information contained in the consumer confidence report is correct.
[
53296
]
Chlorine and Chloramines Residual Reporting (DS)
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This form reports the distribution system chlorine residual or chloramine residual for the applicable public water system. It certifies all residual disinfectant sampling have been properly carried out in the distribution system.
[
53295
]
Chlorine and Chloramines Residual Reporting (POE)
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This form reports the Point of Entry chlorine residual or chloramine residual for the applicable public water system. It certifies all residual disinfectant sampling have been properly carried out at the point of entry/entry point.
[
55275
]
Consumer Notice of Lead Result in Drinking Water
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
All public water systems that monitor for lead and copper are required to complete the consumer notice of lead result form and certification form. This form verifies the public water system delivered the consumer notice of lead result to the correct customers.
[
55656
]
Electronic Sample Entry (eSE) Subscriber Agreement
[
PDF
]
Program:
Water Quality - DW
The Electronic Sample Entry (eSE) Subscriber Agreement should be used by laboratories that process drinking water sampling results that would like to report the sampling results electronically using IDEM eSE application; it may also be used to change/update status information from a previously submitted Agreement. Submission of drinking water sampling results electronically is an alternative to using paper forms to fulfill reporting requirements.
[
54188
]
Emergency Drinking Water Construction Permit Request Form
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This drinking water construction permit application form is only used for an emergency condition as a result of a drought, storm, flood, or other natural or manmade disaster.
[
54186
]
Filter Backwash Recycling Rule (FBRR) Recordkeeping
[
PDF
]
Program:
Water Quality - DW
This form is for systems to record their filter backwash recycling information. Systems need to keep these records on file.
[
53294
]
IE/LT1 SWTR Combined Filter Effluent Turbidity
[
PDF
]
Program:
Water Quality - DW
This is for surface water public water systems to record their daily combined filter effluent turbidity results.
[
53285
]
Inorganic Chemicals (IOC's) IN Drinking Water
[
PDF
]
Program:
Water Quality - DW
This form is for reporting the public water supply compliance monitoring results for Inorganic Chemicals.
[
53289
]
Lead & Copper (PBCU) In Drinking Water Reporting
[
PDF
]
Program:
Water Quality - DW
This form is for reporting the public water supply compliance monitoring results for lead and copper.
[
52998
]
Level 1 Assessment - Non-Transient Non-Community (NTNC) or Community Water Systems (CWS)
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
The Revised Total Coliform Rule requires PWSs to investigate the system when monitoring results may be vulnerable to contamination. A Level 1 Assessment form must be conducted or managed by a responsible party of the Public Water System (e.g. a certified operator for the community or nontransient noncommunity system). This Level 1 Assessment form is only for Non Transient Non-Community or Community Water Systems.
[
52999
]
Level 1 Assessment - Transient Non-Community Water Systems
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
The Revised Total Coliform Rule requires PWSs to investigate the system when monitoring results may be vulnerable to contamination. This form must be completed by a manager or owner for a transient noncommunity water system. This Level 1 Assessment form is only for Transient Non-Community Water Systems.
[
55981
]
Level 2 Assessment - Non-Transient Non-Community (NTNC) or Community Water Systems (CWS)
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
Under the Revised Total Coliform Rule, a Level 2 Assessment needs to be completed when a Public Water Supply has a second level 1 trigger within a rolling 12 month period or an E. Coli Maximum Contaminant Level Violation. The Level 2 Assessment needs to be conducted and recorded by IDEM staff or State Approved Entity. This form is specifically for Non-Transient Non-Community or Community Water System.
[
55983
]
Level 2 Assessment - Transient Non-Community Water Systems
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
Under the Revised Total Coliform Rule, a Level 2 Assessment needs to be completed when a Public Water Supply has a second level 1 trigger within a rolling 12 month period or an E. Coli Maximum Contaminant Level Violation. The Level 2 Assessment needs to be conducted and recorded by IDEM staff or State Approved Entity. This form is specifically for Transient Non-Community.
[
53290
]
Monthly Bromate Reporting
[
PDF
]
Program:
Water Quality - DW
This form is for public water systems that use Ozone as treatment to report their monthly Bromate results.
[
53282
]
Monthly Chlorine Dioxide Monitoring
[
PDF
]
Program:
Water Quality - DW
This form is for applicable public water systems to report their monthly chloride dioxide monitoring results.
[
53283
]
Monthly Chlorite Monitoring
[
PDF
]
Program:
Water Quality - DW
This form is for applicable public water systems to report their monthly chlorite monitoring results.
[
53293
]
Monthly Individual Filter Effluent (IFE) Turbidity Monitoring
[
PDF
]
Program:
Water Quality - DW
This is for surface water public water systems to record their monthly individual filter effluent turbidity results.
[
34609
]
Monthly Report of Operation of Water Treatment Plant
[
PDF
]
Program:
Water Quality - DW
This form is for public water systems to record their monthly physical and chemical data parameters.
[
53284
]
Monthly Total Organic Carbon Removal Reporting
[
PDF
]
Program:
Water Quality - DW
This form is for applicable public water systems to report their monthly total organic carbon removal.
[
56206
]
New Public Water Supply Well Pump Test Report
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This form is for public water systems to report the well pump test data for any new PWS wells.
[
46977
]
New System Questionnaire
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This form is for new public water systems to record their system type, mailing information, operator information, owner information and billing information.
[
50896
]
New Well Site Application
[
DOC
]
Program:
Water Quality - DW
This form needs to be completed when public water systems are proposing a new well site location.
[
53281
]
Nitrate & Nitrite In Drinking Water
[
PDF
]
Program:
Water Quality - DW
This form is for public water systems to report their compliance monitoring results for Nitrate and Nitrite.
[
56823
]
Notice of Public Education Certification
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This Notice of Public Education certification form needs to be completed and submitted to IDEM when a public water system must deliver a public education notice following any system wide lead action level exceedance.
[
56391
]
Radionuclides Reporting
[
PDF
]
Program:
Water Quality - DW
This form is for community public water systems report their Radionuclide compliance monitoring results.
[
55927
]
Seasonal Systems Start-up Requirements
[
PDF
]
Program:
Water Quality - DW
Per the Revised Total Coliform Rule, seasonal public water systems must complete this checklist when starting up their system. It will aid in preventing contamination from entering your public water system.
[
53001
]
Seasonal Systems Start-up Requirements (Hand Pump(s) Only)
[
PDF
]
Program:
Water Quality - DW
Per the Revised Total Coliform Rule, seasonal public water systems with hand pump wells must complete this checklist when starting up their system. It will aid in preventing contamination from entering your public water system.
[
54923
]
Stage 2 Disinfectants and Disinfection Byproducts Rule Reporting
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This is for applicable public water systems to report their Stage 2 Disinfection Byproducts, Total Trihalomethanes and Haloacetic Acids, compliance monitoring locations and results.
[
55261
]
Stage 2 Operational Evaluation - Distribution System
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
Per the Stage 2 Disinfection Byproducts Rule, applicable public water systems to need to conduct an operational evaluation when notified by IDEM and submit this report to IDEM.
[
55263
]
Stage 2 Operational Evaluation - Source Water
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
Per the Stage 2 Disinfection Byproducts Rule, applicable public water systems to need to conduct an operational evaluation when notified by IDEM and submit this report to IDEM.
[
55260
]
Stage 2 Operational Evaluation - Summary
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
Per the Stage 2 Disinfection Byproducts Rule, applicable public water systems to need to conduct an operational evaluation when notified by IDEM and submit this report to IDEM.
[
55262
]
Stage 2 Operational Evaluation - Treatment Process
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
Per the Stage 2 Disinfection Byproducts Rule, applicable public water systems to need to conduct an operational evaluation when notified by IDEM and submit this report to IDEM.
[
53287
]
Synthetic Organic Compounds (SOC's) In Drinking Water
[
PDF
]
Program:
Water Quality - DW
This form is for Community and Nontransient public water systems to report their compliance monitoring results for Synthetic Organic Compounds (SOC's).
[
53297
]
Total Coliform / Groundwater Rule Reporting
[
PDF
]
Program:
Water Quality - DW
This form is for public water systems to report their Total Coliform results.
[
53016
]
Total Coliform Site Sampling Plan- Non-Transient Non-Community Water Systems (NTNC)
[
PDF
]
Program:
Water Quality - DW
This form is for Non-Transient Non-Community Water Systems to record their Total Coliform sample site locations and report their Total Coliform sample plan to IDEM.
[
55982
]
Total Coliform Site Sampling Plan- Transient Non-Community Water Systems (TNC)
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This form is for Transient Non-Community Water Systems to record their Total Coliform sample site locations and report their Total Coliform sample plan to IDEM.
[
53288
]
Trihalomethanes (TTHM) And Haloacetic Acids (HAA5) Analyses In Drinking Water
[
PDF
]
Program:
Water Quality - DW
This is for applicable public water systems to report their Stage 2 Disinfection Byproducts, Total Trihalomethanes and Haloacetic Acids, compliance monitoring locations and results.
[
53286
]
Volatile Organic Compounds (VOC's) In Drinking Water
[
PDF
]
Program:
Water Quality - DW
This form is for community and nontransient public water systems to report their compliance monitoring results for Volatile Organic Compounds (VOC's).
[
53292
]
Water Quality Parameters And Source Water Reporting
[
PDF
]
Program:
Water Quality - DW
This is for community and nontransient public water systems to report their water quality parameter results to IDEM. This form can also be used to report source water results for lead and copper.
[
53249
]
Certified Operator in Responsible Charge (CORC) Request for Information ¿ Operator of Multiple Public Water Systems
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This form is a request for information for the certified operator in responsible charge of multiple public water systems.
[
45675
]
Drinking Water Certification: Application for Approval of Continuing Education Training
[
PDF
]
Program:
Water Quality - DW
This application form must be completed for all drinking water training courses for which continuing education credits will be given. The notice of application approval and the IDEM approval must be obtained before continuing education contact hours are given.
[
45674
]
Drinking Water Certification: Continuing Education Credit Report
[
PDF
]
Program:
Water Quality - DW
This form must be completed in order for the attendee to get credit for their drinking water operator continuing education contact hours.
[
53210
]
Facility Specific Operator (FSO): Application for Water Treatment Plan and Water Distribution System Operator Certification
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This application form must be submitted to IDEM when applying for a Facility Specific Operator for water treatment plant and water distribution system operator certification.
[
12094
]
Public Water Supply: Application For Water Treatment Plant and Water Distribution System Operator Certification
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This application form must be submitted to IDEM when applying for a Water Treatment Plant and/or Distribution System Operator Certification.
[
54189
]
Indiana Wellhead Protection Phase I Application
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
This purpose of this Phase I Wellhead Protection plan application is to lay out the framework for the wellhead protection plan.
[
53117
]
Indiana Wellhead Protection Phase II Application
[
PDF
]
Program:
Water Quality - DW
The purpose of the Phase II Wellhead Protection plan application is to document the implementation of the Phase I plan.
[
53796
]
Indiana Wellhead Protection Phase II Five Year Update Survey
[
PDF
]
[
DOC
]
Program:
Water Quality - DW
The purpose of the five (5) year updates is to complete updates of the information on a routine basis ensuring so that the Wellhead protection plan contains current information.
[
54297
]
Source Water Proximity Determination Request
[
PDF
]
Program:
Water Quality - DW
The purpose of this form is for individuals to submit a source water proximity determination request to IDEM. We encourage you to use our self-service Source Water Proximity Determination Tool if it suits your needs https://www.in.gov/idem/cleanwater/pages/wellhead/
[
50000
]
Application for Approval to Use Water Treatment Additives
[
PDF
]
Program:
Water Quality - Permitting
The application used by facilities requesting approval to use a water treatment additive in part of their process.
[
50271
]
Application for Industrial Wastewater Pretreatment (IWP) Permit
[
PDF
]
Program:
Water Quality - Permitting
The application used for industrial facilities wishing to discharge effluent to a municipal sewer system.
[
53161
]
Application for Industrial Wastewater Treatment Construction Permit Per 327 IAC 3
[
DOC
]
Program:
Water Quality - Permitting
The application used by industries seeking a permit for construction of a new wastewater treatment plant or modification or expansion to an existing facility.
[
53912
]
Application for Preliminary Effluent Limitations
[
PDF
]
[
DOC
]
Program:
Water Quality - Permitting
The application used when proposing a new or increased discharge to request what the anticipated effluent limitations for subsequent permit actions would be.
[
53160
]
Application for Wastewater Treatment Plant Construction Permit Per 327 IAC 3
[
DOC
]
Program:
Water Quality - Permitting
The application used by municipalities, utilities, and semi-public entities seeking a permit for construction of a new wastewater treatment plant or change to an existing facility.
[
49456
]
Identification of Potentially Affected Parties
[
PDF
]
[
DOC
]
Program:
Water Quality - Permitting
A form that consists of a list of all people or groups who may be interested or impacted by the activities or existence of a treatment plant, and which is required to accompany all applications for permit actions.
[
52111
]
Industrial Streamlined Mercury Variance (SMV) Application
[
PDF
]
[
DOC
]
Program:
Water Quality - Permitting
The application for industrial facilities interested in a new or renewed streamlined variance from the water quality criteria that is the basis for mercury water quality based effluent limitations.
[
30530
]
Monthly Monitoring Report (MMR) for Industrial Discharge Permits
[
XLS
]
Program:
Water Quality - Compliance
This form is used to submit Monthly Monitoring Report (MMR) for Industrial Discharge Permits.
[
56109
]
Monthly Monitoring Report (MMR) for Wet Weather Treatment Facilities
[
XLS
]
Program:
Water Quality - Compliance
This form is used to submit Monthly Monitoring Report (MMR) for Wet Weather Treatment Facilities.
[
10829
]
Monthly Report of Operation Activated Sludge Type Wastewater Treatment Plant - Expanded
[
XLS
]
Program:
Water Quality - Compliance
This form is used to submit the Monthly Report of Operation for the Activated Sludge Type of Wastewater Treatment Plants.
[
53343
]
Monthly Report of Operation Lagoon Type Wastewater Treatment Plant
[
XLS
]
Program:
Water Quality - Compliance
This form is used to submit the Monthly Report of Operation for the Lagoon Type of Wastewater Treatment Plants.
[
53344
]
Monthly Report of Operation Package Type Wastewater Treatment Plant - Less than 0.05 mgd
[
XLS
]
Program:
Water Quality - Compliance
This form is used to submit the Monthly Report of Operation for the Package Type of Wastewater Treatment Plants.
[
53339
]
Monthly Report of Operation Sequencing Batch Reactor Wastewater Treatment Plant
[
XLS
]
Program:
Water Quality - Compliance
This form is used to submit the Monthly Report of Operation for Sequencing Batch Reactor Wastewater Treatment Plants.
[
53340
]
Monthly Report of Operation Trickling Filter or RBC Wastewater Treatment Plant
[
XLS
]
Program:
Water Quality - Compliance
This form is used to submit the Monthly Report of Operation for Trickling Filter or RBC Wastewater Treatment Plants.
[
53341
]
Monthly Report of Operation Vertical Loop Reactor Wastewater Treatment Plant
[
XLS
]
Program:
Water Quality - Compliance
This form is used to submit the Monthly Report of Operation for Vertical Loop Reactor Wastewater Treatment Plants.
[
55044
]
Municipal Chloride Variance Application
[
DOC
]
Program:
Water Quality - Permitting
The application for municipal facilities interested in a new or renewed variance from the water quality criteria that is the basis for chloride water quality based effluent limitations.
[
52112
]
Municipal Streamlined Mercury Variance (SMV) Application
[
PDF
]
[
DOC
]
Program:
Water Quality - Permitting
The application for municipal facilities interested in a new or renewed streamlined variance from the water quality criteria that is the basis for mercury water quality based effluent limitations.
[
50546
]
National Pollutant Discharge Elimination System (NPDES) CSO Monthly Report of Operations and Instructions
[
XLS
]
Program:
Water Quality - Compliance
This form is used to create a CSO Monthly report of Operations (MRO)
[
56913
]
Notice of Intent (NOI) Letter for ING420000 Temporary Discharges General NPDES Permit
[
PDF
]
[
DOC
]
Program:
Water Quality - Permitting
The application for entities seeking coverage under the General NPDES Permit for temporary discharges pursuant to NPDES Permit Number ING420000.
[
55637
]
NPDES Form 2C Application Package
[
PDF
]
Program:
Water Quality - Drinking Water & Wastewater Facilities
Form used by existing facilities for discharging process wastewater.
[
55639
]
NPDES Form 2E Application Package
[
PDF
]
Program:
Water Quality - Drinking Water & Wastewater Facilities
Form used for existing facilities with current or planned direct discharge of non-process wastewater, and which do not discharge process water.
[
49401
]
NPDES General Permit Notice of Intent Submittal Application
[
PDF
]
Program:
Water Quality - Drinking Water & Wastewater Facilities
Form used to submit applications for intent to dispose of waste in a manner that meets general permit notice requirements
[
51952
]
NPDES Industrial Permit Information Application Instructions General Information Form
[
PDF
]
Program:
Water Quality - Drinking Water & Wastewater Facilities
General information form for NPDES Industrial permit application
[
50103
]
NPDES Public Water Supply Permit Application Package
[
PDF
]
Program:
Water Quality - Drinking Water & Wastewater Facilities
Form used for Public Water Supplies with a direct discharge of filtered backwash or lime softener wastewater.
[
54924
]
NPDES Semi Public and Minor Municipal Permit Application
[
PDF
]
[
DOC
]
Program:
Water Quality - Drinking Water & Wastewater Facilities
Form is used as a cover sheet to serve as a notice of intent for a NPDES permit application.
[
47289
]
Wastewater Operator Certification: Application for Wastewater Treatment Plant Operator Certification Examination
[
PDF
]
Program:
Water Quality - Compliance & Enforcement
This form is used to apply for approval to sit for the wastewater treatment plant operator certification exam.
[
53583
]
Wastewater Operator Certification: Application for Wastewater Treatment Plant Operator Certification Examination
[
PDF
]
Program:
Water Quality - Compliance & Enforcement
This form is used to apply for approval to sit for the wastewater treatment plant operator certification exam as an apprentice before meeting the requirements.
[
53785
]
Wastewater Operator Apprentice: Application for Wastewater Treatment Plant Apprentice to Request Certification
[
PDF
]
Program:
Water Quality - Compliance & Enforcement
This form is used to apply for a license when an apprentice has met the requirements to become an operator.
[
51494
]
Wastewater Operator Provisional Certification: Application for Provisional Wastewater Treatment Plant Operator Certification
[
PDF
]
Program:
Water Quality - Compliance & Enforcement
This form is used to apply for a Provisional wastewater operator certification when a facility is suddenly without an operator in charge.
[
51138
]
Wastewater Operator Continuing Education: Application for Approval of Continuing Education
[
PDF
]
Program:
Water Quality - Compliance & Enforcement
This form is used for training providers to request approval for courses offered for continuing education hours for wastewater operators.
[
51139
]
Wastewater Operator Continuing Education: Credit Report
[
PDF
]
Program:
Water Quality - Compliance & Enforcement
This form is used for training providers and/or operators to submit for proof of continuing education hours taken.
[
56893
]
Joint IDEM-DNR Waterways Application for Construction and for Discharge of Dredged or Fill Material to Waters of the State
[
PDF
]
Program:
Water Quality - Surface Water
An application to obtain permit coverage for either wetlands 401 WQC or isolated wetlands and in addition apply for DNR Construction in the Floodway.
[
54185
]
Rule 6: General Permit Annual Report
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to report progress to comply at the end of each year ((based on permit start date).
[
53590
]
Rule 6: Industrial Storm Water Discharge Monitoring Report
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to report stormwater sampling results.
[
51286
]
Rule 6: Notice of Intent (NOI) Letter
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to apply for permit coverage.
[
51287
]
Rule 6: Storm Water Pollution Prevention Plan (SWP3)
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to certify that the SWP3 for the permitted facility meets the requirements of the Rule.
[
54087
]
Rule 6: Notice of Termination/Exclusion (NOT/E) Letter
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to terminate permit coverage and apply for no exposure certification.
[
51276
]
Rule 13: Monthly Summary Report of Construction Projects
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used by MS4s to report status of construction projects
[
51270
]
Rule 13: Notice of Intent (NOI) Letter
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to apply for permit coverage.
[
51277
]
Rule 13: Storm Water Quality Management Plan (SWQMP) Part A: Initial Application Certification Submittal and Checklist
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to apply for permit coverage.
[
51275
]
Rule 13: Storm Water Quality Management Plan (SWQMP) Part B: Baseline Characterization and Report Certification Checklist
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to apply for permit coverage and also as part of a programmatic update.
[
51280
]
Rule 13: Storm Water Quality Management Plan (SWQMP) Part C: Program Implementation Certification Checklist
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to apply for permit coverage and also as part of a programmatic update.
[
51937
]
Wetlands: Section 401 WQC Regional General Permit Notification Form
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
Form used to submit applications for intent to disturb a wetland in a manner that meets general permit notice requirements. Do not use this form if you will impact any isolated wetlands
[
55220
]
Hoosier Riverwatch Water Monitoring Equipment Application
[
PDF
]
[
DOC
]
Program:
Water Quality - Watershed Assessment and Planning
Required online application to request stream monitoring equipment for volunteer monitors
[
55189
]
Hoosier Riverwatch Workshop Evaluation
[
PDF
]
[
DOC
]
Program:
Water Quality - Watershed Assessment and Planning
Form that trained volunteers complete after a HRW workshop to evaluate the instructor and workshop content.
[
55188
]
Hoosier Riverwatch Workshop Registration
[
PDF
]
[
DOC
]
Program:
Water Quality - Watershed Assessment and Planning
Required paperwork for HRW volunteers which includes their contact information.
[
55190
]
Hoosier Riverwatch Workshop Summary
[
PDF
]
[
DOC
]
Program:
Water Quality - Watershed Assessment and Planning
Required form for facilitator/instructor to complete after a ¿workshop which includes information about workshop, location, expenses, number of participants, etc.
[
50067
]
Itemization of Invoice Expenditures
[
PDF
]
[
DOC
]
Program:
Water Quality - Watershed Assessment and Planning
The Itemization of Invoice Expenditures form requires itemization of the expenses the Grantee is requesting for reimbursement. It must be submitted with the invoice to receive reimbursement.
[
50066
]
Report of In-kind/Cash Match Contributions
[
PDF
]
[
DOC
]
Program:
Water Quality - Watershed Assessment and Planning
The Report of In-Kind / Cash Match Contributions form describes the in-kind and/or cash match that has been provided for the project.
[
53970
]
Section 205 Nonpoint Source Pollution Grant Application
[
PDF
]
[
DOC
]
Program:
Water Quality - Watershed Assessment and Planning
Universities, and local, state, and federal governmental agencies must use this form to apply for 205J funding.
[
49367
]
Section 319 Nonpoint Source Pollution Grant Application
[
PDF
]
[
DOC
]
Program:
Water Quality - Watershed Assessment and Planning
Nonprofit organizations, universities, and local, state, and federal governmental agencies must use this form to apply for 319 funds.
[
50068
]
Section 319 & 205j Grant Program Progress Report Form
[
PDF
]
[
DOC
]
Program:
Water Quality - Watershed Assessment and Planning
This form describes the work accomplished for which reimbursement is requested and must be submitted with each invoice (or at least quarterly)¿with¿approximate¿percent complete of the task should be in line with the percent of grant funds spent
[
50065
]
Section 319: 319A (Agriculture) Cost Share Form
[
PDF
]
Program:
Water Quality - Watershed Assessment and Planning
Completed when requesting reimbursement from the 319 Program for eligible cost-share and/or demonstration best management practices (BMPs) implemented on¿agriculture land¿
[
50063
]
Section 319: 319U (Urban) Cost Share Form
[
PDF
]
Program:
Water Quality - Watershed Assessment and Planning
Completed when requesting reimbursement from the 319 Program for eligible cost-share and/or demonstration best management practices (BMPs) implemented on urban land
[
53035
]
Cross Connection Control/Backflow Inspector Renewal
[
PDF
]
Program:
Water Quality - Compliance
To renew Cross Connection Control Device/Backflow Inspector.
[
53920
]
Late Notification of Transfer of Ownership Request for NPDES Permit
[
PDF
]
[
DOC
]
Program:
Water Quality - Drinking Water & Wastewater Facilities
This form is utilized for notification of a transfer of ownership to IDEM less than thirty (30) day prior to the proposed ownership date.
[
53049
]
Construction Stormwater Residential Development Registration
[
PDF
]
[
DOC
]
Program:
Water Quality - Drinking Water & Wastewater Facilities
The purpose of this form is the establish responsibility for an individual lot operator to comply with specific requirements with and under Section 3.8 of the Construction Stormwater General Permit (CSGP).
[
55917
]
Notice of Intent (NOI) Letter for ING490000 Sand and Gravel General NPDES Permit
[
PDF
]
[
DOC
]
Program:
Water Quality - Drinking Water & Wastewater Facilities
This form is used to apply for coverage under the General NPDES Permit for wastewater from sand, gravel, dimension stone, and crushed stone operations pursuant to NPDES Permit No. ING490000.
[
53101
]
Construction Stormwater Posting Project Information
[
PDF
]
[
DOC
]
Information for posting construction stormwater projects.
[
56679
]
Construction Stormwater - Signed Certification
[
PDF
]
[
DOC
]
The final step to complete online applications for permit coverage and termination under the Construction Stormwater General Permit
[
51957
]
NPDES Form 2D Application Package
[
PDF
]
Program:
Water Quality - Drinking Water & Wastewater Facilities
Form used for proposed new sources or new dischargers of process wastewater.
[
53159
]
Application for Sanitary Sewer Construction
[
DOC
]
Program:
Water Quality - Permitting
The application used to receive a permit for the construction of sanitary sewer lines.
[
51514
]
Rule 5: Notice of Termination (NOT) Storm Water Runoff Associated With Construction Activity
[
PDF
]
[
DOC
]
[
WEBFORM
]
Program:
Water Quality - Surface Water
This form is used to terminate permit coverage.
[
47290
]
Wastewater Operator Certification: Application for Wastewater Treatment Plant Operator Certification by Reciprocity
[
PDF
]
Program:
Water Quality - Compliance & Enforcement
This form is used to apply for an Indiana wastewater license based on holding a license in another state.
[
51271
]
Municipal Separate Storm Sewer System General Permit (MS4GP): Minimum Control Measure Certification
[
PDF
]
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to certify that the program MCM has been developed and the MS4 is ready to implement.
[
49008
]
Notice of Intent to Construct a Water Main Extension
[
PDF
]
Program:
Water Quality - DW
The Notice of Intent form is required under the general permitting rule for construction of main extension projects in the water distribution system. The use of NOI forms allows construction to begin 30 days after IDEM receipt of form.
[
53050
]
NOTICE OF INTENT (NOI) FORM GENERAL NPDES PERMIT ING410000 FOR ONSITE RESIDENTIAL SEWAGE DISCHARGING DISPOSAL SYSTEMS IN ALLEN COUNTY, IN
[
DOC
]
Program:
Water Quality - Permits
This form must be used to apply for coverage under the General NPDES Permit for Onsite Residential Sewage Discharging Disposal Systems in Allen County, Indiana pursuant to NPDES Permit No. ING410000.
[
55411
]
Hoosier Water Guardian Award Application
[
PDF
]
Program:
Water Quality - DW
This application form is for public water system to apply for a Hoosier Water Guardian Award. The Hoosier Water Guardian is awarded to recipients that go above and beyond for their source water protection.
[
53027
]
Industrial Stormwater No Exposure Application
[
PDF
]
[
DOC
]
Program:
Water Quality - Permits
[
51278
]
Municipal Separate Storm Sewer System General Permit (MS4GP) Annual Report
[
DOC
]
Program:
Water Quality - Surface Water
This form is used to report progress to comply at the end of each year.
[
51821
]
Wetlands: Application For Authorization to Discharge Dredged or Fill Material to Isolated Wetlands and/or Waters of the State
[
DOC
]
Program:
Water Quality - Surface Water
This form is to be used for those who intend to discharge dredged or fill materials into wetlands, isolated wetlands, or any other water body regulated under state and federal law. Specifically, this form is used if the project is not covered by the Indiana Regional General Permit or if the activities are authorized under the State Regulated Wetland General Permits.
[
57155
]
State Regulated Wetland Class Determination Worksheet
[
DOC
]
Program:
Water Quality - Permitting
[
35058
]
Application for Construction Permit For Public Water System
[
PDF
]
Program:
Water Quality - DW
The purpose is for public water systems to submit this permit application form to IDEM when planning to construct, install or modify any facility, equipment, or device for any public water system.
[
48373
]
Bypass/Overflow Incident Report
[
PDF
]
Program:
Water Quality - Compliance
This form is used to report a spill or release incident
[
52415
]
Noncompliance 24-hour Notification Report
[
DOC
]
Program:
Water Quality - Compliance
This form is used to report a non-compliance within 24 hours.
[
55945
]
Notice of Intent (NOI) Letter for ING080000 Ground Water Petroleum Remediation General NPDES Permit
[
PDF
]
[
DOC
]
Program:
Water Quality - NPDES General Permits
[
55918
]
Notice of Intent (NOI) Letter for ING670000 Hydrostatic Testing of Commercial Pipelines General NPDES Permit
[
PDF
]
[
DOC
]
Program:
Water Quality - NPDES General Permits
[
55916
]
Notice of Intent (NOI) Letter for ING250000 Once Through Noncontact Cooling Water General NPDES Permit
[
PDF
]
[
DOC
]
Program:
Water Quality - NPDES General Permits
[
55919
]
Notice of Intent (NOI) Letter for ING340000 Petroleum Products Terminals General NPDES Permit
[
PDF
]
[
DOC
]
Program:
Water Quality - NPDES General Permits
[
53463
]
Monthly Report of Operation Activated Sludge Type Wastewater Treatment Plant - Standard
[
XLS
]
Program:
Water Quality - Compliance
This form is used to submit the Monthly Report of Operation for the Activated Sludge Type of Wastewater Treatment Plants.