About IDEM Forms
The IDEM Agency Forms page provides a one-stop collection for all forms used in IDEM programs, permits, applications, etc. There are a number of ways to use this section and find the forms you need:
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Forms Navigation
The complete collection of all forms used for and by IDEM, organized by topic:
- Agency Forms
- Office of Air Quality
- Office of Land Quality
- Auto Salvage Recyclers
- Confined Feeding Operations
- Electronic Waste
- Hazardous Waste Facilities
- Institutional Controls
- Land Application of Biosolids and Other Pollutant-bearing Waters
- Legitimate Use Approvals
- Satellite Manure Storage Structures (SMSS)
- Solid Waste Facilities
- State Cleanup Program
- Petroleum Branch
- Voluntary Remediation Program
- Waste Classifications
- Waste Tires
- Wastewater (Septage) Program
- Yard Waste Composting Program
- Office of Program Support
- Office of Water Quality
- Other Non-Agency Forms
- Auditor of the State of Indiana
- Indiana Bureau of Motor Vehicles
- Indiana Department of Administration
- Indiana Department of Local Government Finance
- Indiana Department of Natural Resources
- Indiana State Board of Accounts
- Indiana State Department of Health
- U.S. Environmental Protection Agency
- U.S. Internal Revenue Service
Forms by Topic
Agency Forms
- IDEM Complaint Form - 50014 [PDF]
- IDEM Online Complaint Form - 57061 [WEBFORM]
- IDEM Online Questions/Comments Form - 57060 [WEBFORM]
- Public Records Request Form - 55542 [PDF], 55542 [DOC]
Office of Air Quality
Clean Air Interstate Rule (CAIR)
- EE-01 EE/RE Set Aside NOx Allowance Application - 52719 [PDF], 52719 [DOC]
- EE-02 Ozone Control Period Notification of Results - 52720 [PDF], 52720 [DOC]
- EE-03 EE/RE Set Aside Nox Allowance Reapplication - 52721 [PDF], 52721 [DOC]
Voluntary Idling Program
- Voluntary Idling Pledge - 53902 [PDF]
Permits Branch
General Source Data
- Air Permit Application Cover Sheet - 50639 [DOC]
- Air Permit Application Form Checklist - 51607 [DOC]
- GSD-01 General Source Data - Basic Source Level Information - 50640 [DOC]
- GSD-02 General Source Data - Plant Layout Diagram - 51605 [DOC]
- GSD-03 General Source Data - Process Flow Diagram - 51599 [DOC]
- GSD-04 General Source Data - Stack / Vent Information - 51606 [DOC]
- GSD-05 General Source Data - Emissions Unit Information - 51610 [DOC]
- GSD-06 General Source Data - Particulate Emissions - 51612 [DOC]
- GSD-07 General Source Data - Criteria Pollutant Emissions Summary - 51602 [DOC]
- GSD-08 General Source Data - Hazardous Air Pollutant Emissions Summary - 51604 [DOC]
- GSD-09 General Source Data - Summary of Additional Information - 51611 [DOC]
- GSD-10 General Source Data - Insignificant Activity - 51596 [DOC]
- GSD-11 General Source Data - Alternative Operating Scenario Summary - 51601 [DOC]
- GSD-12 General Source Data - Affidavit of Non-applicability - 51600 [DOC]
- GSD-13 General Source Data - Affidavit of Applicability - 51603 [DOC]
- GSD-14 General Source Data - Owners and Occupants Notified - 51609 [DOC]
- GSD-15 General Source Data - Government Officials Notified - 51608 [DOC]
- Air Permit Application - Renewal Checklist - 51755 [DOC]
Process Information
- AEF-01 Alternative Emissions Factor Request - 51860 [DOC]
- PI-01 Miscellaneous Processes - 52534 [DOC]
- PI-02A Combustion Unit Summary - 52535 [DOC]
- PI-02B Combustion: Boilers, Process Heaters, & Furnaces - 52536 [DOC]
- PI-02C Combustion: Turbines & Internal Combustion Engines - 52537 [DOC]
- PI-02D Combustion: Incinerators & Combustors - 52538 [DOC]
- PI-02E Combustion: Kilns - 52539 [DOC]
- PI-02F Combustion: Fuel Use - 52540 [DOC]
- PI-02G Combustion: Emission Factors - 52541 [DOC]
- PI-02H Combustion: Federal Rule Applicability - 52542 [DOC]
- PI-03 Storage and Handling of Bulk Material - 52543 [DOC]
- PI-04 Asphalt Plants - 52544 [DOC]
- PI-05 Brick / Clay Products - 52545 [DOC]
- PI-06 Electroplating Operations - 52546 [DOC]
- PI-07 Welding Operations - 52547 [DOC]
- PI-08 Concrete Batchers - 52548 [DOC]
- PI-09 Degreasing - 52549 [DOC]
- PI-10 Dry Cleaners - 52550 [DOC]
- PI-11 Foundry, Smelting, and Die Cast Operations - 52551 [DOC]
- PI-12 Grain Elevators - 52552 [DOC]
- PI-13 Lime Manufacturing - 52553 [DOC]
- PI-14 Volatile Organic Liquid Compound Storage - 52554 [DOC]
- PI-14 ALT Alternate Version of Volatile Organic Liquid Compound Storage - 52555 [DOC]
- PI-15 Portland Cement Manufacturing - 52556 [DOC]
- PI-16 Reinforced Plastics & Composites - 52557 [DOC]
- PI-17 Blasting Operations - 52558 [DOC]
- PI-18 Mineral Processing - 52559 [DOC]
- PI-19 Surface Coating & Printing Operations - 52560 [DOC]
- PI-20 Woodworking / Plastic Machining - 52561 [DOC]
- PI-21 Site Remediation - 52570 [DOC]
Control Equipment
- CE-01 Control Equipment Summary - 51904 [DOC]
- CE-02 Particulate Control Equipment Baghouse or Fabric Filter - 51953 [DOC]
- CE-03 Particulate Control - Cyclone - 52620 [DOC]
- CE-04 Particulate Control - Electrostatic Precipitator - 52621 [DOC]
- CE-05 Particulate Control - Wet Collector / Scrubber / Absorber - 52622 [DOC]
- CE-06 Organics - Flare / Oxidizer / Incinerator - 52623 [DOC]
- CE-07 Organics - Absorbers - 52624 [DOC]
- CE-08 Organics - Condenser - 52625 [DOC]
- CE-09 Nitrogen Oxides - Reduction Technology - 52626 [DOC]
- CE-10 Miscellaneous Control Equipment - 52436 [DOC]
Compliance Determination for Part 70 Sources
- CD-01 Emissions Unit Compliance Status - 51861 [DOC]
- CD-02 Compliance Plan Requirements Per Applicable Requirement - 51862 [DOC]
- CD-03 Compliance Plan Requirements Per Emissions Unit - 51863 [DOC]
- CD-04 Compliance Schedule and Certification - 51864 [DOC]
Emission Credit Registry
- EC-01 Emission Credit Registry - Generation of Emission Credits - 51783 [DOC]
- EC-02 Emission Credit Registry - Transfer of Emission Credits - 51784 [DOC]
- EC-03 Emission Credit Registry - Use of Emission Credits - 51785 [DOC]
- EC-04 Emission Credit Registry - Emission Credits Request - 51906 [DOC]
Plantwide Applicability Limits
- PAL-01: Actuals Plantwide Applicability Limit - 52451 [DOC]
- PAL-02: Revised Plantwide Applicability Limit - 52452 [DOC]
- PAL-03: Plantwide Applicability Limit Renewal - 52453 [DOC]
- PAL-04: Request for Termination of Plantwide Applicability Limit - 52454 [DOC]
Air Toxics
- FED-01 - Summary of Federal Requirements - NSPS & NESHAP - 53512 [DOC]
- FED-02 MACT Pre-Construction Review - 51905 [DOC]
- FED-03 Compliance Assurance Monitoring - 53377 [DOC]
- U.S. EPA: FED-03 Initial Notification [DOC]
Special Permits
- Phase II Acid Rain Permit
- Phase II Acid Rain Certificate of Representation [PDF]
- Phase II Acid Rain Allowance Transfer Form [PDF]
- Phase II Acid Rain General Account Form [PDF]
- Phase II Acid Rain Permit Application Form [PDF]
- Phase II Acid Rain New Unit Exemption Form [PDF]
- Phase II Acid Rain Retired Unit Exemption Form [PDF]
- Phase II Acid Rain NOx Compliance Plan [PDF]
- Phase II Acid Rain NOx Averaging Plan [PDF]
- Phase II Acid Rain Additional Information, Instructions, and Forms
Source Specific Operating Agreements (SSOA) Instructions (Forms Under Development)
- OA-01 Summary of Application and Existing Agreements OA-01 [DOC]
- OA-02 Industrial / Commercial Surface Coating Operations -OR- Graphic Arts Operations (326 IAC 2-9-2.5) OA-02 [DOC]
- OA-03 Surface Coating or Graphic Arts Operations (326 IAC 2-9-3) OA-03 [DOC]
- OA-04 Woodworking Operations (326 IAC 2-9-4) OA-04 [DOC]
- OA-05 Abrasive Cleaning Operations (326 IAC 2-9-5) OA-05 [DOC]
- OA-06 Grain Elevators (326 IAC 2-9-6) OA-06 [DOC]
- OA-07 Sand And Gravel Plants (326 IAC 2-9-7) OA-07 [DOC]
- OA-08 Crushed Stone Processing Plants (326 IAC 2-9-8) OA-08 [DOC]
- OA-09 Ready-Mix Concrete Batch Plants (326 IAC 2-9-9) OA-09 [DOC]
- OA-10 Coal Mines And Coal Preparation Plants (326 IAC 2-9-10) OA-10 [DOC]
- OA-11 Automobile Refinishing Operations (326 IAC 2-9-11) OA-11 [DOC]
- OA-12 Degreasing Operations (326 IAC 2-9-12) OA-12 [DOC]
- OA-13 External Combustion Sources (326 IAC 2-9-13) OA-13 [DOC]
- OA-14 Internal Combustion Sources (326 IAC 2-9-14) OA-14 [DOC]
Compliance Branch
- Drycleaner Notification Form - 48625 [DOC]
- Drycleaner Notification of Compliance Status - 53430 [DOC]
- Initial Notification Report Under Regulation 40 CFR Part 63, Subpart DDDDD - 51956 [PDF]
- Outdoor Hydronic Heater Dealer Notice to Buyers - 53597 [PDF], 53597 [DOC]
Asbestos
- Application Checksheet for Asbestos Contractor - 52571 [DOC]
- Application for Asbestos Contractor License - 52575 [DOC]
- Application for Asbestos Training Course - Provider Approval - 48741 [DOC]
- Application for Duplicate Asbestos License - 48740 [DOC]
- Application for Individual Asbestos License - 43786 [DOC]
- Notification of Demolition and Renovation Operations - 44593 [PDF]
Open Burning
- Identification of Potentially Affected Persons - 49635 [PDF], 49635 [DOC]
- Notification of Exempt Live Fire Training Under 326 IAC 4-1 - 54801 [PDF], 54801 [DOC]
- Request for Air Curtain Destructor Approval Under 326 IAC 4-1 - 43688 [PDF], 43688 [DOC]
- Request for Fire Training Approval Under 326 IAC 4-1 - Acquired Structure - 49634 [PDF], 49634 [DOC]
- Request for Fire Training Approval Under 326 IAC 4-1 - Motor Vehicle - 50337 [PDF], 50337 [DOC]
- Request for Fire Training Approval Under 326 IAC 4-1 - Stationary Facility - 55543 [PDF], 55543 [DOC]
- Request for Prescribed Vegetation Burn Approval Under 326 IAC 4-1 - 50864 [PDF], 50864 [DOC]
- Request for Tree or Clean Wood Waste Burn Approval Under 326 IAC 4-1 - 43692 [PDF], 43692 [DOC]
Stack Test Forms
- Compliance Test Protocol Form - 55003 [PDF]
- RATA Notification Protocol Form - 55059 [PDF]
- VOCs & Toxics Compliance Test Protocol Form - 55058 [PDF]
Programs Branch
- AES-01 Air Emission Statement Certification - 52052 [PDF], 52052 [DOC]
- AES-02 General Facility Information - 52053 [PDF], 52053 [DOC]
- AES-03 Stack Information - 52054 [PDF], 52054 [DOC]
- AES-04 Abatement Equipment - 52055 [PDF], 52055 [DOC]
- AES-05 Group/Process/Emissions Information - 52056 [PDF], 52056 [DOC]
- AES-06 Voluntary Hazardous Air Pollutant Reporting - 52057 [PDF], 52057 [DOC]
DieselWise
Office of Land Quality
- Adjacent Landowner/Occupant Affidavit - 51872 [DOC]
- Field Tile Monitoring At Land Application Sites (Personal Document) - 51910 [DOC]
- IDEM Dry Cleaner and Laundry (DCaL) Dataset - 57059 [WEBFORM]
- IDEM e-Submission Enrollment - 57103 [WEBFORM]
Auto Salvage Recyclers
- Auto Salvage Recyclers Environmental Self-Audit Checklist - 53765 [PDF]
- Automotive Salvage Recycler License Application - 40248 [PDF]
- Claim for Payment for Mercury Switches from End-of-life Vehicles - 53238 [PDF], 53238 [DOC]
- Indiana Clean Yard Best Management Practices Checklist - 53924 [DOC]
- Indiana Clean Yard Certification Statement - 53766 [PDF]
Confined Feeding Operations
- Complete CFO/CAFO Application Packet - 55051 [PDF], 55051 [DOC]
CFO Forms
- CFO Closure Certification - 55054 [PDF], 55054 [DOC]
- CFO Construction Affidavit - 51255 [PDF], 51255 [DOC]
- CFO Construction Notification - 50210 [PDF], 50210 [DOC]
- CFO Facility Change Notification - 50209 [PDF], 50209 [DOC]
- CFO Request for Approval Transfer - 49832 [PDF], 49832 [DOC]
- CFO Request for Approval to Surface Apply Manure to Frozen or Snow-Covered Ground - 55162 [PDF], 55162 [DOC]
- CFO Request for Exiting the Program - 49827 [PDF], 49827 [DOC]
- Professional Engineer Certification Construction of Concrete Liquid Manure Storage Structures - 55053 [PDF], 55053 [DOC]
- Professional Engineer Certification Construction of Earthen Liquid Manure Storage Structures - 55052 [PDF], 55052 [DOC]
- Professional Engineer Certification for Construction of Geomembrane Lined Liquid Manure Storage Structures - 55716 [PDF], 55716 [DOC]
The following operator record forms and documents are not returned to IDEM:
- CFO Emergency Notification for Manure Application to Frozen or Snow-Covered Ground [PDF]
- CFO Emergency Spill Response Documentation [DOC]
- CFO Emergency Spill Response Plan [DOC]
- CFO Manure Application Record [DOC]
- CFO Manure Distribution Record [DOC]
- CFO Manure Land Usage Agreement [DOC]
- CFO Marketing or Distribution of Manure Information Sheet - 56029 [PDF], 56029 [DOC]
- CFO Self-Inspection Records [DOC]
- CFO Storm Water Management Certification [DOC]
- CFO Storm Water Management Requirements for Concentrated Animal Feeding Operations [DOC]
The following compliance information forms and documents are not required, but recommended to be maintained on site:
NPDES CAFO Individual Permit Forms
- CAFO Annual Report - 52510 [PDF]
- CAFO Closure of Manure, Litter, Process Wastewater Storage Structures - 51913 [PDF]
- CAFO Construction Completion Affidavit - 55056 [PDF]
- CAFO Construction Notification - 51911 [PDF]
- CAFO Removal from NPDES CAFO Permit Program - 55055 [PDF]
The following operator record forms are not returned to IDEM:
- 2015 Self Inspection Sheet [XLS]
- CAFO Emergency Spill Response Documentation [DOC]
- CAFO Emergency Spill Response Plan [DOC]
- CAFO Land Usage Agreement [PDF]
- CAFO Manure Application Record [PDF]
- CAFO Manure Distribution Record [PDF]
- CAFO Marketing or Distribution of Manure Information Sheet [PDF]
- CAFO Precipitation Events at Land Application Sites [PDF]
Electronic Waste
- Registration Form for Storage and Processing Facilities - 54138 [PDF]
Hazardous Waste Facilities
- Biennial Report CC - Closure/Post Closure Cost Estimate - 52387 [PDF], 52387 [DOC]
- Facility Permit Fee Transmittal - 47214 [DOC]
- Hazardous Waste Disposal Fee - 46244 [PDF], 46244 [DOC]
- Transfer Facilities Notification - 52123 [PDF], 52123 [DOC]
- Used Oil Management Report - 52392 [PDF], 52392 [DOC]
Guidance:
- Post-Closure Permit Application Guidance [DOC]
- Post-Closure Permit Application Checklist [DOC]
- RCRA Part B Permit Application Checklist [PDF]
- RCRA Part B Permit Application Checklist Comments [DOC]
Institutional Controls
- Environmental Restrictive Covenant / Deed Notice Modification or Termination Request - 56082 [PDF], 56082 [DOC]
- Institutional Controls Self Audit Checklist - 55715 [PDF]
- Notice of Contamination in Right of Way – 57234 [PDF]
Land Application of Biosolids and Other Pollutant-bearing Waters
- Notification for the Construction of a Storage Structure for Biosolids/Industrial Waste Product or Pollutant-bearing Water - 50405 [DOC]
- Permit Application for the Construction of a Storage Structure for Biosolids/Industrial Waste Product or Pollutant-Bearing Water - 50406 [DOC]
- Notification for the Land Application of Agricultural Lime Substitute - 50407 [DOC]
- Permit Application for the Marketing and/or Distribution of Biosolids - 50408 [DOC]
- Permit Application for the Land Application of Domestic Wastewater - 50409 [DOC]
- Permit Application for the Land Application of Biosolids - 50410 [DOC]
- Permit Application for the Marketing and/or Distribution of Industrial Waste Products - 53514 [DOC]
- Permit Application for the Land Application of Industrial Waste Products - 53517 [DOC]
- Notification for the Land Application of Small Quantities of Pollutant-bearing Water - 53558 [DOC]
- Permit Application for the Land Application of Industrial Process Wastewater - 53584 [DOC]
Legitimate Use Approval
- Legitimate Use Approval Application Checklist - 52954 [PDF]
Satellite Manure Storage Structures (SMSS)
- Professional Engineer Certification for Construction of Geomembrane Lined Liquid Satellite Manure Storage Structures - 53084 [PDF]
- Satellite Manure Storage Structure (SMSS) Completed Construction Affidavit - 53083 [PDF]
- Satellite Manure Storage Structure (SMSS) Construction of Concrete Liquid Manure - 53086 [PDF]
- Satellite Manure Storage Structure (SMSS) Construction of Earthen Liquid Manure - 53085 [PDF]
- Satellite Manure Storage Structure (SMSS) Construction Notification - 53037 [PDF]
- Satellite Manure Storage Structure (SMSS) Facility Change Notification - 53081 [PDF]
- Satellite Manure Storage Structure (SMSS) Permit Application Packet - 56423 [PDF], 56423 [DOC]
- Satellite Manure Storage Structure (SMSS) Request for Permit Transfer - 53082 [PDF]
Solid Waste Facilities
- Adjacent Landowner/Occupant Affidavit - 51872 [PDF], 51872 [DOC]
- Alternative Fuel Processor Registration Application - 55308 [PDF]
- Biomass Digester/Gasification Facility Registration Application - 55309 [PDF]
- Insignificant Permit Modification Checklist Solid Waste Land Disposal Facilities - 53317 [DOC]
- Mobile Home Salvaging Facility Registration Application - 55307 [PDF]
- Municipal Solid Waste Landfill Closure Plan (329 IAC 10-22) - 50391 [DOC]
- Municipal Solid Waste Landfill Post-Closure Plan (329 IAC 10-23) - 50388 [DOC]
- Solid Waste Facility Permit Application & Registration Fee Transmittal - 47215 [PDF], 47215 [DOC]
- Solid Waste Facility Transfer Application - 50393 [PDF]
- Solid Waste Land Disposal Facilities Renewal Application Checklist - 53088 [PDF], 53088 [DOC]
- Solid Waste Land Disposal Facility Permit Application - 50404 [PDF], 50404 [DOC]
- Solid Waste Land Disposal Facility Permit Renewal Application - 50386 [PDF], 50386 [DOC]
- Solid Waste Processing Facilities and Incinerators / New Facility and Major Modification Permit Application Checklist - 53315 [PDF], 53315 [DOC]
- Solid Waste Processing Facility Permit Application - 50392 [PDF], 50392 [DOC]
- Solid Waste Processing Facilities Renewal Application Checklist - 56418 [PDF], 56418 [DOC]
- Solid Waste Processing Facility Permit Renewal Application - 50387 [PDF], 50387 [DOC]
- Solid Waste Quarterly Fees - 56723 [PDF]
State Cleanup Program
- Remediation Services Branch Annual Report - 57108 [DOC]
- Remediation/Progress Monitoring (R/PM) Cover Sheet and Report Format - 57327 [PDF]
- Site Characterization Report Cover Sheet/Checklist - 57385 [PDF], 57385 [DOC]
Petroleum Branch
Aboveground Storage Tank Program
- Initial Registration for Aboveground Storage Tanks - 57298 [PDF]
- Notification for Aboveground Storage Tanks - 57335 [PDF]
Contractor Certification Program
- Application for Underground Storage Tank Certification - 53148 [PDF]
- Application for Renewal of Underground Storage Tank Certification - 53150 [PDF]
Excess Liability Trust Fund (ELTF)
- ELTF Claims Application (Phase Approach) - 56424 [XLSB]
- ELTF Claims Application (Costs incurred prior to 1/1/2016) - 47139 [XLS]
- ELTF Eligibility Application - 55459 [PDF]
- 50% Reimbursement ELTF Eligibility Application for UST Decommissioning/Replacement - 57299 [PDF]
- 50% Reimbursement ELTF Claims Application for UST Decommissioning/Replacement - 57322 [XLSX]
- ELTF Scope of Work for Leaking UST Sites - 51955 [XLS]
Petroleum Remediation Program
- Independent Closure Process - Site Closure - 54166 [PDF], 54166 [XLS]
- LUST Further Site Investigation (FSI) Report Cover Sheet & Report Format - 55441 [PDF], 55441 [DOC]
- LUST Initial Incident Report - 54487 [PDF], 54487 [DOC]
- LUST Initial Site Characterization (ISC) Checklist - 55440 [PDF], 55440 [DOC]
- LUST Initial Site Characterization (ISC) Report Cover Sheet & Report Format - 55439 [PDF], 55439 [DOC]
- LUST No Further Action Request Cover Sheet and Report Format - 56088 [PDF], 56088 [DOC]
- LUST Quarterly Monitoring Report (QMR) Cover Sheet and Report Format - 56087 [PDF], 56087 [DOC]
Underground Storage Tank (UST) Program
- Initial Registration for Underground Storage Tank Systems - 56548 [PDF]
- Notification for Underground Storage Tank Systems - 45223 [PDF]
- Sellers Notification for Underground and Aboveground Storage Tanks - 56967 [PDF]
- Thirty (30) Day Notification of Intent to Close - 56553 [PDF]
- Underground Storage Tank Systems Closure Report - 56554 [PDF]
Voluntary Remediation Program
- Application and Instructions - 47271 [PDF], 47271 [DOC]
- Remediation Completion Report Completeness Checklist - 54168 [PDF]
- Remediation/Progress Monitoring (R/PM) Cover Sheet and Report Format - 57327 [PDF]
- Remediation Services Branch Annual Report - 57108 [DOC]
- Remediation Work Plan Completeness Checklist - 53413 [PDF]
- Voluntary Remediation Investigation Plan Checklist - 57371 [PDF]
Waste Classifications
- Waste Classification Application Checklist - 52953 [PDF]
Waste Tires
- Application for Waste Tire Processing Operation Registration (or Renewal) - 47221 [PDF]
- Application for Waste Tire Storage Site Registration (or Renewal) - 47222 [PDF]
- Application for Waste Tire Transporter Registration (or Renewal) - 47220 [DOC]
- Contingency Plan for Waste Tire Processing Operations and Storage Sites - 54817 [PDF]
- Registered Tire Storage Site Closure Cost Estimate - 53784 [DOC]
- Waste Tire Grant Expenditure Report 57242 [PDF], 57242 [DOC]
- Waste Tire Grant Program Application - 57241 [DOC], 57241 [PDF]
- Waste Tire Grant Program Final Report - 57240 [PDF]
- Waste Tire Manifest - 47273 [PDF]
- Waste Tire Facility Closure Notification - 55351 [DOC]
Wastewater (Septage) Program
- Application for a Wastewater (Septage) Management Land Application Site Permit - 50403 [DOC]
- Application for a Wastewater (Septage) Management Storage/Treatment Facility Permit - 50402 [DOC]
- Application for Septage Management Business Permit - 50399 [DOC]
- Septage Land Application Quarterly Report - 50397 [PDF], 50397 [XLS]
Yard Waste Composting Program
- Yard Waste Composting Facility Registration Application - 50414 [PDF], 50414 [DOC]
Office of Program Support
- Good Character Disclosure Statement - 50400 [PDF], 50400 [DOC]
- Grant Expenditure Report - 51986 [PDF], 51986 [DOC]
Clean Community Program
- Clean Community Program Application - 51826 [DOC]
Clean Marina Program
- Indiana Clean Boater Pledge - 53581 [PDF], 53581 [DOC], 53581 [WEBFORM]
- Indiana Clean Marina Program Application - 53567 [XLSX]
- Indiana Clean Marina Pledge - 53582 [PDF]
Environmental Stewardship Program
- Environmental Stewardship Program Annual Performance Report - 53475 [PDF], 53475 [DOC]
- Environmental Stewardship Program Application - 52772 [PDF], 52772 [DOC]
- Environmental Stewardship Program Checklist for Potential Regulatory Incentives - 53706 [PDF], 53706 [DOC]
Governor’s Award for Environmental Excellence
- Governor's Award for Environmental Excellence - 57196 [DOC], 57196 [WEBFORM]
Partnerships
- Partners for Clean Air: Annual Award Nomination – 55675 [WEBFORM]
- Partners for Clean Air Annual Membership Pledge – 56138 [WEBFORM]
- Partners for Pollution Prevention Application - 56504 [PDF], 56504 [DOC]
Pollution Prevention Grants
- Indiana Pollution Prevention (P2) Grant Program Application - 53334 [PDF], 53334 [DOC]
- Partners for Clean Air PCA Scholarship Application - 56875 [DOC]
Recycling
- Community Recycling Grant Expenditure Report - 51986 [PDF]
- Community Recycling Grant Program Application Package - 56847 [PDF], 56847 [DOC]
- Community Recycling Grant Personnel Activity Report - 56962 [PDF]
- Community Recycling Grant Program Final Report - 56957 [PDF], 56957 [DOC]
- Recycling Activity Report for Recycler Facility - Recycling Activity Report [PDF]
Recycling Market Development Program
- Central Indiana Waste Diversion Pilot Project Application - 53076 [DOC]
- Recycling Market Development Grant Expenditure Report - 54926 [PDF]
- Recycling Market Development Grant Final Report - 54922 [PDF]
- Recycling Market Development Grant Progress Report - 54921 [PDF]
- Recycling Market Development Grant Proposal Submission - 56936 [WEBFORM]
Self-Disclosure and Environmental Audit
- Self-Disclosure and Environmental Audit Application Form - 55075 [PDF], 55075 [DOC]
Office of Water Quality
Drinking Water & Wastewater Facilities
Public Water Supply
- Application for Construction Permit For Public Water System - 35058 [PDF], 35058 [DOCX]
- Asbestos Monitoring Waiver Certification Statement - 56955 [PDF], 56955 [DOC]
- Backflow Device Test Form - 55788 [PDF], 55788 [DOC]
- Determination of Groundwater Under the Direction of Influence of Surface Water - 49187 [PDF]
- CCR Electronic Delivery Certification - Drinking Water - 55623 [PDF], 55623 [DOC]
- CCR Certification in Drinking Water - 54187 [PDF]
- Chlorine and Chloramines Residual Reporting (DS) - 53296 [PDF], 53296 [DOC]
- Chlorine and Chloramines Residual Reporting (POE) - 53295 [PDF], 53295 [DOC]
- Consumer Notice of Lead Result in Drinking Water - 55275 [PDF], 55275 [DOC]
- Electronic Sample Entry (eSE) Subscriber Agreement - 55656 [PDF]
- Emergency Drinking Water Construction Permit Request Form - 54188 [PDF], 54188 [DOC]
- Filter Backwash Recycling Rule (FBRR) Recordkeeping - 54186 [PDF]
- IE/LT1 SWTR Combined Filter Effluent Turbidity - 53294 [PDF]
- Inorganic Chemicals (IOC's) IN Drinking Water - 53285 [PDF]
- Joint IDEM-DNR Waterways Application for Construction and for Discharge of Dredged or Fill Material to Waters of the State - 56893 [PDF]
- Lead & Copper (PBCU) In Drinking Water Reporting - 53289 [PDF]
- Level 1 Assessment - Non-Transient Non-Community (NTNC) or Community Water Systems (CWS) - 52998 [PDF], 52998 [DOC]
- Level 1 Assessment - Transient Non-Community Water Systems - 52999 [PDF], 52999 [DOC]
- Level 2 Assessment - Non-Transient Non-Community (NTNC) or Community Water Systems (CWS) - 55981, [PDF], 55981 [DOC]
- Level 2 Assessment - Transient Non-Community Water Systems - 55983 [PDF], 55983 [DOC]
- Monthly Bromate Reporting - 53290 [PDF]
- Monthly Chlorine Dioxide Monitoring - 53282 [PDF]
- Monthly Chlorite Monitoring - 53283 [PDF]
- Monthly Individual Filter Effluent (IFE) Turbidity Monitoring - 53293 [PDF]
- Monthly Report of Operation of Water Treatment Plant - 34609 [PDF]
- Monthly Total Organic Carbon Removal Reporting - 53284 [PDF]
- New Public Water Supply Well Pump Test Report - 56206 [PDF], 56206 [DOC]
- New System Questionnaire - 46977 [PDF], 46977 [DOC]
- New Well Site Application - 50896 [PDF], 50896 [DOC]
- Nitrate & Nitrite In Drinking Water - 53281 [PDF]
- Notice of Intent to Construct a Water Main Extension - 49008 [PDF]
- Notice of Public Education Certification - 56823 [PDF], 56823 [XLS]
- Radionuclides Reporting - 56391 [PDF]
- Reporting of Aboveground Storage Tanks - 55906 [PDF]
- Seasonal Systems Start-up Requirements - 55927 [PDF]
- Seasonal Systems Start-up Requirements (Hand Pump(s) Only) - 53001 [PDF]
- Stage 2 Disinfectants and Disinfection Byproducts Rule Reporting - 54923 [PDF], 54923 [DOC]
- Stage 2 Operational Evaluation - Distribution System - 55261 [PDF], 55261 [DOC]
- Stage 2 Operational Evaluation - Source Water - 55263 [PDF], 55263 [DOC]
- Stage 2 Operational Evaluation - Summary - 55260 [PDF], 55260 [DOC]
- Stage 2 Operational Evaluation - Treatment Process - 55262 [PDF], 55262 [DOC]
- Synthetic Organic Compounds (SOC's) In Drinking Water - 53287 [PDF]
- Total Coliform / Groundwater Rule Reporting - 53297 [PDF]
- Total Coliform Site Sampling Plan- Non-Transient Non-Community Water Systems (NTNC) - 53016 [PDF]
- Total Coliform Site Sampling Plan- Transient Non-Community Water Systems (TNC) - 55982 [PDF], 55982 [DOC]
- Trihalomethanes (TTHM) And Haloacetic Acids (HAA5) Analyses In Drinking Water - 53288 [PDF]
- Volatile Organic Compounds (VOC's) In Drinking Water - 53286 [PDF]
- Water Quality Parameters And Source Water Reporting - 53292 [PDF]
Wastewater Facilities
- Wastewater Reporting Notices and Instructions (MROs and MMRs)
- Application for Approval to Use Water Treatment Additives - 50000 [PDF]
- Application for Industrial Wastewater Pretreatment (IWP) Permit - 50271 [PDF]
- Application for Industrial Wastewater Treatment Construction Permit Per 327 IAC 3 - 53161 [DOC]
- Application for Preliminary Effluent Limitations - 53912 [PDF], 53912 [DOC]
- Application for Sanitary Sewer Construction - 53159 [DOC]
- Application for Wastewater Treatment Plant Construction Permit Per 327 IAC 3 - 53160 [DOC]
- Bypass/Overflow Incident Report - 48373 [PDF]
- Identification of Potentially Affected Parties - 49456 [PDF], 49456 [DOC]
- Industrial Streamlined Mercury Variance (SMV) Application - 52111 [PDF], 52111 [DOC]
- Late Notification of Transfer of Ownership Request for NPDES Permit - 53920 [DOC] 53920 [PDF]
- Monthly Monitoring Report (MMR) for Industrial Discharge Permits - 30530 [XLS]
- Monthly Monitoring Report (MMR) for Wet Weather Treatment Facilities - 56109 [XLS]
- Monthly Report of Operation Activated Sludge Type Wastewater Treatment Plant - Expanded - 10829 [XLS]
- Monthly Report of Operation Activated Sludge Type Wastewater Treatment Plant - Standard - 53463 [XLS]
- Monthly Report of Operation Lagoon Type Wastewater Treatment Plant - 53343 [XLS]
- Monthly Report of Operation Package Type Wastewater Treatment Plant - Less than 0.05 mgd - 53344 [XLS]
- Monthly Report of Operation Sequencing Batch Reactor Wastewater Treatment Plant - 53339 [XLS]
- Monthly Report of Operation Trickling Filter or RBC Wastewater Treatment Plant - 53340 [XLS]
- Monthly Report of Operation Vertical Loop Reactor Wastewater Treatment Plant - 53341 [XLS]
- Municipal Chloride Variance Application - 55044 [DOC]
- Municipal Streamlined Mercury Variance (SMV) Application - 52112 [PDF], 52112 [DOC]
- National Pollutant Discharge Elimination System (NPDES) CSO Monthly Report of Operations (MRO) and Instructions - 50546 [XLS]
- Noncompliance 24-hour Notification Report - 52415 [DOC]
- Notice of Intent (NOI) Form General NPDES Permit ING410000 for Onsite Residential Sewage Discharging Disposal Systems in Allen County, IN - 53050 [PDF]
- Notice of Intent (NOI) Letter for ING080000 Ground Water Petroleum Remediation General NPDES Permit - 55945 [PDF], 55945 [DOC]
- Notice of Intent (NOI) Letter for ING250000 Once Through Noncontact Cooling Water General NPDES Permit - 55916 [PDF], 55916 [DOC]
- Notice of Intent (NOI) Letter for ING340000 Petroleum Products Terminals General NPDES Permit - 55919 [PDF], 55919 [DOC]
- Notice of Intent (NOI) Letter for ING420000 Temporary Discharges General NPDES Permit - 56913 [PDF], 56913 [DOC]
- Notice of Intent (NOI) Letter for ING490000 Sand and Gravel General NPDES Permit - 55917 [DOC], 55917 [PDF]
- Notice of Intent (NOI) Letter for ING670000Hydrostatic Testing of Commercial Pipelines General NPDES Permit - 55918 [PDF], 55918 [DOC]
- NPDES Form 2C Application Package - 55637 [PDF]
- NPDES Form 2D Application Package - 51957 [PDF]
- NPDES Form 2E Application Package - 55639 [PDF]
- NPDES General Permit Notice of Intent Submittal Application - 49401 [PDF]
- NPDES Industrial Permit Information Application Instructions General Information Form - 51952 [PDF]
- NPDES Public Water Supply Permit Application Package - 50103 [PDF]
- NPDES Semi Public and Minor Municipal Permit Application - 54924 [PDF], 54924 [DOC]
- Quarterly Monitoring Report (QMR) - 57318 [XLS]
- Quarterly Monitoring Report extended version (QMR) - 57144 [XLS]
Operator Certification and Continuing Education
- Certified Operator in Responsible Charge (CORC) Request for Information - Operator of Multiple Public Water Systems - 53249 [PDF], 53249 [DOC]
- Drinking Water Certification: Application for Approval of Continuing Education Training - 45675 [PDF]
- Drinking Water Certification: Continuing Education Credit Report - 45674 [PDF]
- Facility Specific Operator (FSO): Application for Water Treatment Plan and Water Distribution System Operator Certification - 53210 [PDF], 53210 [DOC]
- Public Water Supply: Application For Water Treatment Plant and Water Distribution System Operator Certification - 12094 [PDF], 12094 [DOC]
- Public Water Supply: Certified Operator in Responsible Charge (CORC) Request for Information - Operator of Multiple Public Water Systems - 53249 [PDF], 53249 [DOC]
- Wastewater Operator Certification: Application for Wastewater Treatment Plant Operator Certification Examination - 47289 [PDF]
- Wastewater Operator Certification: Application for Wastewater Treatment Plant Operator Certification Examination - Short Form for Apprenticeship Only - 53583 [PDF]
- Wastewater Operator Apprentice: Application for Wastewater Treatment Plant Apprentice to Request Certification - 53785 [PDF]
- Wastewater Operator Provisional Certification: Application for Provisional Wastewater Treatment Plant Operator Certification - 51494 [PDF]
- Wastewater Operator Certification: Application for Wastewater Treatment Plant Operator Certification by Reciprocity - 47290 [PDF]
- Wastewater Operator Continuing Education: Application for Approval of Continuing Education - 51138 [PDF]
- Wastewater Operator Continuing Education: Credit Report - 51139 [PDF]
Storm Water
- Construction Stormwater Residential Development Registration - 53049 [DOC] 53049 [PDF]
- Construction Stormwater Posting Project Information - 53101 [PDF], 53101 [DOCX]
- Construction Stormwater - Signed Certification - 56679 [PDF], 56679 [DOCX]
- Municipal Separate Storm Sewer System General Permit (MS4GP) Annual Report - 51278 [DOC]
- Municipal Separate Storm Sewer System General Permit (MS4GP): Minimum Control Measure Certification - 51271 [PDF], 51271 [DOC]
- Rule 5: Notice of Termination (NOT) Storm Water Runoff Associated with Construction Activity - 51514 [PDF], 51514 [DOC], 51514 [WEBFORM]
- Rule 6: General Permit Annual Report - 54185 [PDF], 54185 [DOC]
- Rule 6: Industrial Storm Water Discharge Monitoring Report - 53590 [PDF], 53590 [DOC]
- Rule 6: Notice of Intent (NOI) Letter - 51286 [PDF], 51286 [DOC]
- Rule 6: Storm Water Pollution Prevention Plan (SWP3) - 51287 [PDF], 51287 [DOC]
- Rule 6: Notice of Termination/Exclusion (NOT/E) Letter - 54087 [PDF], 54087 [DOC]
- Rule 13: Monthly Summary Report of Construction Projects - 51276 [PDF], 51276 [DOC]
- Rule 13: Notice of Intent (NOI) Letter - 51270 [PDF], 51270 [DOC]
- Rule 13: Storm Water Quality Management Plan (SWQMP) - Part A: Initial Application Certification Submittal and Checklist - 51277 [PDF], 51277 [DOC]
- Rule 13: Storm Water Quality Management Plan (SWQMP) - Part B: Baseline Characterization and Report Certification Checklist - 51275 [PDF], 51275 [DOC]
- Rule 13: Storm Water Quality Management Plan (SWQMP) - Part C: Program Implementation Certification Checklist - 51280 [PDF], 51280 [DOC]
Wetlands
- Section 401 WQC - Wetlands, Lakes and Streams Pre-Filing Meeting Request Form - 57030 N [PDF], 57030 N [DOC]
- Application For Authorization to Discharge Dredged or Fill Material to Isolated Wetlands and/or Waters of the State - 51821 [PDF], 51821 [DOC]
- Section 401 NWP and RGP Notification - 51937 [DOC]
Watershed Management
- Hoosier Riverwatch Water Monitoring Equipment Application - 55220 [PDF], 55220 [DOC]
- Hoosier Riverwatch Workshop Evaluation - 55189 [PDF], 55189 [DOC]
- Hoosier Riverwatch Workshop Registration - 55188 [PDF], 55188 [DOC]
- Hoosier Riverwatch Workshop Summary - 55190 [PDF], 55190 [DOC]
- Itemization of Invoice Expenditures - 50067 [PDF], 50067 [DOC]
- Report of In-kind/Cash Match Contributions - 50066 [PDF], 50066 [DOC]
- Section 205 Nonpoint Source Pollution Grant Application - 53970 [PDF], 53970 [DOC]
- Section 319 Nonpoint Source Pollution Grant Application - 49367 [PDF], 49367 [DOC]
- Section 319 & 205j Grant Program Progress Report Form - 50068 [PDF], 50068 [DOC]
- Section 319: 319A (Agriculture) Cost Share Form - 50065 [PDF]
- Section 319: 319U (Urban) Cost Share Form - 50063 [PDF]
Wellhead Protection
- Hoosier Water Guardian Award Application - 55411 [PDF], 55411 [DOC]
- Indiana Wellhead Protection Phase I Application - 54189 [PDF], 54189 [DOC]
- Indiana Wellhead Protection Phase II Application - 53117 [PDF]
- Indiana Wellhead Protection Phase II Five Year Update Survey - 53796 [PDF], 53796 [DOC]
- New Well Site Application - 50896 [DOC]
- Source Water Proximity Determination Request - 54297 [PDF]
Other Non-Agency Forms
Auditor of the State of Indiana
- Automated Direct Deposit Authorization Agreement - 47551 [PDF]
- Vendor Information - 53788 [PDF]
Indiana Bureau of Motor Vehicles
- Application for Salvage Motor Vehicle Business License - 40248 [PDF]
Indiana Department of Administration
- Indiana Economic Impact - Proposals and Contracts - 51778 [PDF], 51778 [XLS]
Indiana Department of Local Government Finance
- Statement for Deduction of Assessed Valuation - 18865 [PDF]
Indiana Department of Natural Resources
- Registration of a Significant Water Withdrawal Facility - 20094 [PDF]
Indiana State Board of Accounts
- Automated Direct Deposit Authorization Agreement - 47551 [PDF]
Indiana State Department of Health
- Water Test Kit Order - 46270 [PDF]
U.S. Environmental Protection Agency
- Application for Permit to Discharge Storm Water Discharges Associated with Industrial Activity, Form 2F NPDES [PDF]
- Boiler MACT Initial Notification: National Emission Standards for Hazardous Air Pollutants (NESHAP) for Major Sources, Boiler MACT Initial Notification [PDF]
- CAIR Permit Application (Sources Covered Under the CAIR SIP) - Part 96 [DOC]
- CAIR Permit Application (Sources Covered under the FIP) - Part 97 [DOC]