UST Forms

Each package contains all the necessary forms and additional information regarding ineligible costs, submission format, etc. Please review all forms thoroughly prior to submission.

Compliance Request

This package should be used as the first submission to the Board. These forms are used to establish your sites compliance status. A $150.00 fee is required with submission of this package. Following the submission of these forms the Department of Environmental Management (DEM) will review the compliance history of your site.

UST Review Board Compliance Application PDF file, less than 1

Request for Reimbursement

Following notification that your site has been found to be “in compliance”, this package should be submitted. These forms are required in order to verify that the release/site is eligible and that the $20,000.00 deductible has been spent on eligible costs.

UST Review Board Request for Reimbursment PDF file, less than 1

Common Forms

These forms are applicable to all reimbursement requests. Where appropriate, forms must be completed and submitted. If a subrogation, disclaimer, and W-9 have previously been filed for a site, do not resubmit.

The forms have been updated (September 2014). The updated Electronic Submission form will replace the Vendor Expenditure and Verification of Payment forms.

Ineligible Expense List PDF file, less than 1

Subrogation Agreement PDF file, less than 1

UST Review Board Disclaimer PDF file, less than 1

W-9 Form PDF file, less than 1

Electronic Submission Instructions PDF file, less than 1

Electronic Submission Instructions Excel file, less than 1