Governor Chris Christie • Lt.Governor Kim Guadagno
  Search
new jersey department of environmental protection
NJ Home Page Services A to Z NJ FAQs NJ Departments/Agencies departments
site remediation program

SRP Home | DEP Home

SRRAForms

  

Site Remediation Reform Act (SRRA) Forms

All forms required to comply with the Administrative Requirements for the Remediation of Contaminated Sites are contained on this web page. Additional forms will be provided as they are finalized.

Important Changes to Forms:

Mandatory DEP Online Services: The Annual Remediation Fee Form and the LSRP Notification of Retention and Dismissal Form have been available as a DEP Online service since September 2012. Unless otherwise instructed by the Department, the use of these services became mandatory on January 18, 2013. The PDF version of these forms have been removed from this page.

General: Checkboxes indicating “Non-LSRP (Existing Cases)”, “LSRP” and “Subsurface Evaluator” have been removed from the Top Header of most forms. This change addresses the fact that all case related documents are to be submitted by LSRPs. Subsurface Evaluators will only use the Full Laboratory Data Deliverables form, Permit by Rule form, and IEC form (and appropriate forms from the UHOT website), therefore, the only forms listed below that still have a Subsurface Evaluator checkbox are these forms.

Remediation Timeframes Form: The Remediation Timeframe Notification Form has replaced the former Remediation Timeframe Extension Request Form. The new form contains two additional checkboxes: “Extension Request” or to “Lengthen the Remedial Investigation Report Timeframe.”

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

Current Forms Note:

The new forms will be required for submittals received by the Department dated May 7, 2012 or later.

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

 
Form Download
 Version &
Date		 Changes Since Last Version Rule
7.5 Percent Cost of Remediation Form Form pdf 51 Kb Instructions pdf 32Kb 1.0 - 5/7/2012 (New)  
Alternative Remedy Application Form Form pdf 57 Kb Instructions pdf 37 Kb 1.3 - 9/13/2012 See Update Log 7:26E-5.1(j)
Alternative Soil Remediation Standard and/or Screening Level Application form Form pdf 131 Kb Instructions pdf 41 Kb 2.1 - 5/7/2012 See Update Log 7:26D-7.4
Annual Remediation Fee Reporting
Pay\Update Online (Requires Login, Service must be Certified by an LSRP) 		  Instructions pdf 25 Kb 1.2 - 5/8/2013 See Update Log  
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 131 Kb Instructions pdf 46 Kb 1.3 - 5/7/2012 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 28 Kb 1.1 - 5/7/2012 See Update Log 7:26C-15.3
Confirmed Discharge Notification form Form pdf 94 Kb Instructions pdf 36 Kb 1.6 - 5/7/2012 See Update Log 7:26E-1.4 
De Minimus Quantity Exemption Application form Form pdf 63 Kb Instructions pdf 74 Kb 1.4 - 8/1/2012 See Update Log 7:26B-5.9
Developer Certification (Appendix A for the ARRCS Rule) Model Document doc 39 Kb       7:26C-13.4 
Discharge to Ground Water Permit by Rule Authorization Request Form pdf 84 Kb Instructions pdf 44 Kb 1.0 - 9/17/2012 See Update Log  
Exemption from Spill Act Liability Certification Form pdf 87 Kb Instructions pdf 27 Kb 1.1 - 4/2/2013 See Update Log  
Full Laboratory Data Deliverables form Form pdf 115 Kb Instructions pdf 35 Kb 1.5 - 9/13/2012 See Update Log 7:26E-1.18 
General Information Notification Form pdf 85 Kb Instructions pdf 33 Kb 1.8 - 9/13/2012 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    
HDSRF Child Care Facility Grant Application Form pdf 131 Kb Instructions pdf 33 Kb 1.0 - 4/25/2013 See Update Log  
IEC Response Action form Form pdf 89 Kb Instructions pdf 36 Kb 1.5 5/7/2012 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/VC - Vapor Intrusion Spreadsheet Spreadsheet xls 39 Kb   1.2 - 8/30/2010    
ISRA Alternate Compliance Option Application Form pdf 58 Kb Instructions pdf 35 Kb 1.5 - 5/7/2012 See Update Log 7:26C-5
ISRA Certificate of Limited Conveyance Application Form pdf 58 Kb Instructions pdf 41 Kb 1.1 - 7/24/2012 See Update Log  

Linear Construction Project

 Form pdf 63Kb Instructions pdf 27 Kb 1.0 - 2/16/12   7:26C-16.2(a)2
LNAPL Free Product Reporting Form Form pdf 87 Kb Instructions 40 Kb 1.6 - 5/7/2012 See Update Log 7:26E-1.12
LSRP Notification of Retention or Dismissal   Instructions 36 Kb 3.0 - 5/7/2012 See Update Log 7:26C-2.3  
LSRP Notification of Retention or Dismissal
Retain/Release Online. (Requires Login, Service must be Certified by an LSRP) 		Instructions pdf 32 Kb 1.1 - 5/8/2013    
Model Deed Notice (Appendix B for the ARRCS Rule) Model Document doc 107 Kb      
Model Termination of Deed Notice (Appendix C for the ARRCS Rule) Model Document doc 96 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 37 Kb Instructions pdf 24 Kb 1.3 - 2/26/2013 See Update Log  
Name and Address Change Reporting Form pdf 56 Kb Instructions pdf 41 Kb 1.1 - 3/13/2013 See Update Log  

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 41 Kb Instructions pdf 33 Kb 1.4 - 5/7/2012 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 463 Kb Instructions pdf 52 Kb 1.7 - 3/25/2013 See Update Log 7:26E-3.1 & 3.3
Public Notification and Outreach form Form pdf 65 Kb Instructions pdf 49 Kb 1.6 - 5/7/2012 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 170 Kb Instructions pdf 50 Kb 1.7 - 5/7/2012 See Update Log 7:26E-1.15 
Well Search Spreadsheet Spreadsheet xls 155 Kb Instructions pdf 35 Kb 1.3 - 3/22/2012 See Update Log  
Remedial Action Report form Form pdf 394 Kb Instructions pdf 46 Kb 1.9 - 5/8/2013 See Update Log 7:26E-6.7
Remedial Action Workplan form Form pdf 434 Kb Instructions pdf 47 Kb 1.6 - 3/25/2013 See Update Log 7:26E-6.2
Remedial Action Permit Application Form for Ground Water Form pdf 165 Kb Instructions pdf 47 Kb 1.5 - 6/19/2012 See Update Log 7:26C-7 

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

 Spreadsheet xls 177 Kb   1.0 - 5/22/2012  

 
Remedial Action Permit Application Form for Soils Form pdf 152 Kb Instructions pdf 52 Kb 1.6 - 7/24/2012 See Update Log 7:26C-7 
Remedial Action Permit Transfer/Change of Ownership Application Form pdf 95 Kb Instructions pdf 40 Kb

1.3 - 6/19/2012

 See Update Log  
Remedial Action Protectiveness / Biennial Certification Form - Ground Water
(Name change. Was "Remedial Action Protectiveness Certification Form - Ground Water")		 Form pdf 195 Kb Instructions pdf 54 Kb

1.5 - 10/5/2012

 See Update Log  

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

Form pdf 141 Kb 

 Instructions pdf 36 Kb 1.6 - 5/7/2012 See Update Log 7:26E-8.4(c)
Remedial Investigation Report form Form pdf 408 Kb Instructions pdf 52 Kb 1.7 - 3/25/2013 See Update Log 7:26E-4.8
Remediation Certification form Form pdf 65 Kb Instructions pdf 31 Kb 1.6 - 11/27/2012 See Update Log 7:26B-4.3 

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

Form pdf 106 Kb Instructions pdf 49 Kb 1.5 - 5/6/2013 See Update Log 7:26C-5 
Remediation Timeframe Notification Form pdf 86 Kb Instructions pdf 37 Kb 1.0 - 5/7/2012 See (New) 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 306 Kb Instructions pdf 50 Kb 2.0 - 3/25/2013 See Update Log 7:26C-6.2 
Model Response Action Outcome (Appendix D for the ARRCS Rule) Model Document doc 126 Kb      
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 7:14B-9.1(c). & 9.2
Vapor Concern (VC) Response Action Form   Form pdf 66 Kb Instructions pdf 35 Kb 1.2 - 5/7/2012 See Update Log 7:26E-1.15(e)
Variance Identification Form Form