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Site Remediation Reform Act (SRRA) Forms

Draft Forms for Rule Proposal
Posted 1 September 2011

The Department recently published a proposal to amend the Administrative Requirements for the Remediation of Contaminated Sites (ARRCS rules), N.J.A.C. 7:26C, the Discharges of Petroleum and Other Hazardous Substances rules, N.J.A.C. 7:1E, the Underground Storage Tanks rules, N.J.A.C. 7:14B, and the Industrial Site Recovery Act rules, N.J.A.C. 7:26B, and to repeal and replace the Technical Requirements for Site Remediation (Technical Requirements), N.J.A.C. 7:26E. The proposal was published in the New Jersey Register at 43 NJR 1935(a).

A notice of the proposal and the proposal itself may be viewed at http://www.nj.gov/dep/rules/notices.html. Proposed new draft forms are available at http://www.nj.gov/dep/srp/srra/forms/proposed.htm.

Modification of the LSRP Notification of Retention or Dismissal form
Posted 28 May 2010

The LSRP Notification of Retention or Dismissal form has been modified to include a self certificating section (Section F) allowing eligible parties to "Opt In" to the LSRP program. See the LSRP Notification of Retention or Dismissal form below.

Special Notice:  If you are an LSRP planning to submit a document

Not all document submittal forms referenced in rules or guidance are currently available.  An LSRP cannot submit any documents until the applicable form is available and an LSRP retention form has been submitted to the Department.  If you are not yet on the SRRA listserv, you should sign up immediately so that you are informed of the most recent postings.  The Department expects to post the remainder of the most critical forms by the end of this week.

In the interim, you may use the Draft forms posted on this page with your submittals until the final form is posted.

The forms required to comply with the Administrative Requirements for the Remediation of Contaminated Sites are contained on this web page. They will be provided as they finalized for use by the LSRP community. "Draft Forms" are included for your review. They are available at the bottom of this web page.

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

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

 

Other SRP Forms

Related Links

Important Notices

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

help for using PDF documents

 

Current Forms

Note: The new forms will be required for submitals received by the Department dated February 28, 2011 or later.

 

Form Download
Version &
Date
Changes Since Last Version Interim Rule
Alternative Remedy Application Form Form pdf 38 Kb Instructions pdf 37Kb 1.0 - 10/31/2011 New Document 7:26E-5.1(j)
Alternative Soil Remediation Standard Application Form pdf 140 Kb Instructions pdf 42 Kb 2.0 - 1/10/2012 See Update Log 7:26D-7.4

Annual Remediation Fee Reporting form

Form pdf 199 Kb Instructions pdf 44 Kb 1.5 - 5/25/2011 See Update Log 7:26C-4.2
Case Inventory Documents Worksheet Spreadsheet xls 20 Kb   1.0 - 11/4/2009    
Case Inventory Documents Example Sheet Example Sheet pdf 20 Kb   1.1 - 1/12/2011 Grammar & punctuation  
Guidance for the Preparation of the Case Inventory Documents Guidance Document pdf 43 Kb   1.1 - 1/12/2011 Grammar & punctuation  
CEA/Well Restriction Area (WRA) Fact Sheet form Form pdf 242 Kb Instructions pdf 56 Kb 1.2 - 5/25/2011 See Update Log 7:26E-6.3
CEA/Well Restriction Area (WRA) Spreadsheet Spreadsheet xls 37 Kb Instructions pdf 29 Kb 1/18/2012 New Document  
Confidentiality Request Form Form pdf 36 Kb Instructions pdf 24 Kb 1.0 - 9/7/2011 New Document 7:26C-15.3
Confirmed Discharge Notification form Form pdf 211 Kb Instructions pdf 39 Kb 1.5 - 5/25/2011 See Update Log 7:26E-1.4 
De Minimus Quantity Exemption Application form Formpdf 168 Kb Instructions pdf 40 Kb 1.3 - 5/25/2011 See Update Log 7:26B-5.9
Developer Certification (Appendix A for the ARRCS Rule) Model Document doc 39 Kb       7:26C-13.4 
Full Laboratory Data Deliverables form Form pdf 230 Kb Instructions pdf 41 Kb 1.3 - 5/25/2011 See Update Log 7:26E-1.18 
General Information Notification Form pdf 186 Kb Instructions pdf 42 Kb 1.6 - 5/25/2011 See Update Log 7:26B-3.3
Hazardous Discharge Site Remediation Fund Application form
Note: See the SRP Financial Assistance HDSRF page for more information & guidance.

Form pdf 347 Kb

Instructions pdf 51 Kb 1.2 - 5/25/2011 See Update Log 7:26C-11.2
HDSRF Application - Cost Estimate Format Spreadsheet Spreadsheet xls 110 Kb   1.0 - 5/21/2010    
IEC Response Action form Form pdf 81 Kb Instructions pdf 36 Kb 1.4 - 1/19/2012 See Update Log 7:26E-1.14  
IEC - Direct Contact Spreadsheet Spreadsheet xls 37 Kb   1.0 - 8/30/2011    
IEC - Potable Water Spreadsheet Spreadsheet xls 42 Kb   1.2 - 8/30/2010    
IEC - Vapor Intrusion Spreadsheet Spreadsheet xls 39 Kb   1.2 - 8/30/2010    
ISRA Alternate Compliance Option Application Form pdf 211 Kb Instructions pdf 43 Kb 1.4 - 5/25/2011 See Update Log 7:26C-5
ISRA Certificate of Limited Conveyance Application Form pdf 150 Kb Instructions pdf 44 Kb 1.0 - 5/25/2011 See Update Log  
LNAPL Free Product Reporting Form Form pdf 97 Kb Instructions 42 Kb 1.5 - 1/31/2012 See Update Log 7:26E-1.12
LSRP Notification of Retention or Dismissal Form pdf 65 Kb Instructions 39 Kb 2.8 - 1/10/2012 See Update Log 7:26C-2.3  
Model Termination of Deed Notice (Appendix B for the ARRCS Rule) Model Document doc 78 Kb       7:26C-13.4 
Monitoring Well Certification Form A - As-Built Certification Form pdf 32 Kb Instructions pdf 21 Kb 1.0 - 9/7/2011 New Document  
Monitoring Well Certification Form B - Location Certification Form pdf 22 Kb Instructions pdf 24Kb 1.1 - 11/28/2011 See Update Log  
Name and Address Change Reporting Form pdf 44 Kb   1.0 - 9/7/2011 New Document  

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

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

Potable Well/Indoor Air Sampling Notification form

Form pdf 159 Kb Instructions pdf 40 Kb 1.3 - 5/25/2011 See Update Log 7:26E-1.4(e)

Sampling Notification Spreadsheet

Spreadsheet xls 42 Kb   1.0 - 2/4/2010    
Preliminary Assessment/Site Investigation form Form pdf 432 Kb Instructions pdf 51 Kb 1.5 - 1/10/2012 See Update Log 7:26E-3.1 & 3.3
Public Notification and Outreach form Form pdf 62 Kb Instructions pdf 38Kb 1.5 - 11/30/2011 See Update Log 7:26E-1.4 
Petroleum UST Fund Application (Regulated) (Closes 6/30/2010) Form pdf 329 Kb Instructions pdf 60 Kb 1.1 - 3/4/2011 See Update Log 7:26C-12.2
Petroleum UST Fund Application (Unregulated) (Including Residential Heating Oil Tanks) Form pdf 338 Kb Instructions pdf 61 Kb 1.1 - 3/4/2011 See Update Log 7:26C-12.2
Project Summary Sheet Spreadsheet Spreadsheet xls 60 Kb   1.0    

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

         
Receptor Evaluation form Form pdf 167 Kb Instructions pdf 47 Kb 1.5 - 10/20/2011 See Update Log 7:26E-1.15 
Well Search Spreadsheet Spreadsheet xls 154 Kb Instructions pdf 35 Kb 1.1 - 1/18/2012 See Update Log  
Remedial Action Report form Form pdf 364 Kb Instructions pdf 46 Kb 1.5 - 1/10/2012 See Update Log 7:26E-6.7
Remedial Action Workplan form Form pdf 398 Kb Instructions pdf 47 Kb 1.4 - 1/10/2012 See Update Log 7:26E-6.2
Remedial Action Permit Application Form for Ground Water Form pdf 169 Kb Instructions pdf 46 Kb 1.3 - 1/18/2012 See Update Log 7:26C-7 

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

Spreadsheet xls 171 Kb   0.0 - 2/24/2010  

 

Remedial Action Permit Application Form for Soils Form pdf 133Kb Instructions pdf 44 Kb 1.3 - 1/18/2012 See Update Log 7:26C-7 
Remedial Action Permit Transfer/Change of Ownership Application Form pdf 210 Kb Instructions pdf 45 Kb

1.1 - 5/25/2011

See Update Log  

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

Form pdf 150 Kb 

Instructions pdf 32 Kb 1.4 - 9/7/2011 See Update Log 7:26E-8.4(c)
Remedial Action Protectiveness / Biennial Certification Form - Ground Water
(Name change. Was "Remedial Action Protectiveness Certification Form - Ground Water")
Form pdf 204 Kb Instructions pdf 48 Kb

1.2 - 9/7/2011

See Update Log  
Remedial Investigation Report form Form pdf 381 Kb Instructions pdf 53 Kb 1.4 - 1/10/2012 See Update Log 7:26E-4.8
Remediation Certification form Form pdf 206 Kb Instructions pdf 40 Kb 1.4 - 5/25/2011 See Update Log 7:26B-4.3 

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

Form pdf 82 Kb Instructions pdf 33 Kb 1.2 - 9/7/2011 See Update Log 7:26C-5 
Remediation Timeframe Extension Request Form pdf 881 Kb Instructions pdf 23 Kb 1.5 - 9/7/11 See Update Log 7:26C-3.2  
Request to Proceed Without Department Pre-Approvals (The Opt In form) See the LSRP Notification of Retention or Dismissal form.         7:26C-2.3  
Response Action Outcome form Form pdf 269 Kb Instructions pdf 50 Kb 1.7 - 1/10/2012 See Update Log 7:26C-6.2 
Technical Assistance Grant form
See the Guidance for Technical Assistance Grants [pdf] for more information.
Form pdf 176 Kb Instructions pdf 35 Kb 1.3 - 5/25/2011 See Update Log 7:26C-10.5 
Underground Storage Tank System Closure Notification / Extension Request form Form pdf 183 Kb Instructions pdf 41 Kb 1.3 - 5/25/2011 See Update Log N.J.A.C. 7:14B-9.1(c). & 9.2
Vapor Concern (VC) Response Action Form   Form pdf 63Kb Instructions pdf 36 Kb 1.1 - 1/19/2012 See Update Log