
				Rod R. Blagojevich, Governor

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environmental
emergencies
only, call the
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Management Agency
800-782-7860
217-782-7860
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Bureau of Land

Land Forms

Brownfields Program Forms Please send all completed forms to: Office of Brownfields Assistance Illinois Environmental Protection Agency 1021 North Grand Avenue East P.O. Box 19276 Springfield, IL 62794-9276
PDF Size	HTML Size	Description
		Instructions for Completing Online Forms
138KB		Municipal Brownfields Redevelopment Grant Amendment Request Form
18KB		Municipal Brownfields Redevelopment Grant Amendment Request Instructions
59KB		Municipal Brownfields Redevelopment Grant Application Checklist
639KB		Municipal Brownfields Redevelopment Grant Application Package
16KB		Municipal Brownfields Redevelopment Grant Match Funding Certification
22KB		Municipal Brownfields Redevelopment Grant Matching Funds Time Report Example
27KB		Municipal Brownfields Redevelopment Grant Quarterly Report Form
19KB		Municipal Brownfields Redevelopment Grant Quarterly Report Form Instructions
28KB		Municipal Brownfields Redevelopment Grant Reimbursement Request Form
17KB		Municipal Brownfields Redevelopment Grant Reimbursement Request Instructions
39KB		Municipal Brownfields Redevelopment Loan Application Package
	4KB	Site Remediation Program Billing and Invoice Procedures
		Site Remediation Program Forms
34KB		Site Remediation Program Assessment of Advance Partial Payment Form (DRM-3)
201KB		Site Remediation Program Request for Review and Evaluation of Plans and Reports Form (DRM-2)

Clean Construction and Demolition Debris Forms

Please send all completed forms to:
Permit Section - Bureau of Land
Illinois Environmental Protection Agency
1021 North Grand Avenue East #33
Springfield, IL 62794-9276

Clean Construction and Demolition Debris Forms

Generator Forms Please send all completed forms to: Waste Reduction and Compliance Section Illinois Environmental Protection Agency 1021 N. Grand Avenue East P.O. Box 19276 Springfield, IL 62794-9276
PDF Size	Description
339KB	2008 Nonhazardous Special Waste Annual Report Forms and Instructions
	2008 Hazardous Waste Report Forms and Instructions
	Annual Generator Special Waste Waste Recertification for Special Waste
14KB	Certificate of Exemption for Automotive Repair and Auto Body Shops
18KB	Illinois EPA Inventory Application
	New Manifest Information (includes links to new USEPA-required manifest forms)
5KB	Manifest Form Selection Information
	(NAICS code(s) - Links to the Census Bureau website
	Notification of Regulated Waste Activity Form (USEPA Form 8700-12) Instructions and Forms Booklet

Household Hazardous Waste Collections Forms
PDF Size	Description
19KB	Application for a One-Day Collection

Industrial Material Exchange Service (IMES)
PDF Size	Description
133KB	Listing Form
54KB	Material Response Form

Leaking UST Program Forms and Model Documents Please send all completed forms and model documents to: Leaking Underground Storage Tank Section Illinois Environmental Protection Agency 1021 North Grand Avenue East P.O. Box 19276 Springfield, IL 62794-9276
Forms
PDF Size	Description
3.8KB	Assignment of UST Fund Payments
	Budget Forms
41KB	Election to Proceed under the Site Remediation Program
	Technical Forms Main Page
Model Documents
HTML Size	Description
4KB	Suggested Letter Template to Request Off-Site Access: This is a suggested letter template for use by the underground storage tank owner or operator to satisfy the requirements of 35 Ill. Adm. Code 732.411(b).
	Institutional Control Model Documents

Manifest Selection Guide and Order Forms Please send all completed forms to: Waste Reduction and Compliance Section - Bureau of Land Illinois Environmental Protection Agency 1021 North Grand Avenue East #24 Springfield, IL 62794-9276
PDF Size	HTML Size	Description
	5KB	Manifest Form Selection Information
		Manifest Online Purchases (by Credit Card)
		New Uniform Hazardous Waste Manifest Forms Information
8KB		PIMW Manifest Request Form

Permits

Please send all completed forms to:
Permit Section - Bureau of Land
Illinois Environmental Protection Agency
1021 North Grand Avenue East #33
Springfield, IL 62794-9276

Permit Forms and Instructions

Site Remediation Program Forms Please send all completed forms to: Site Remediation Program Remedial Project Management Section Bureau of Land Illinois Environmental Protection Agency 1021 North Grand Avenue East P.O. Box 19276 Springfield, IL 62794-9276
PDF Size	Description
370 KB, 7 pages	DRM-1 Instructions and Form
108KB, 4 pages	DRM-2 Instructions and Form
68KB, 3 pages	DRM-3 Instructions and Form
41KB	Leaking UST Election to Proceed under the Site Remediation Program

Tiered Approach to Corrective Action (TACO) Objectives
Model Documents
Description
Institutional Control Model Documents

Transportation Permits Forms The Illinois Environmental Protection Agency (IEPA) regulates the transportation of the following wastes: Used Tires, Special Non-hazardous Waste, Hazardous Waste, and Potentially Infectious Medical Waste (PIMW). There are no manifest requirements for waste tires, but the other programs require that all loads be accompanied by the appropriate manifest forms purchased from the IEPA. Please send all completed forms to: Waste Reduction and Compliance Section Bureau of Land Illinois Environmental Protection Agency 1021 N. Grand Avenue East P.O. Box 19276 Springfield, IL 62794-9276
PDF Size	HTML Size	Description
	5KB	Manifest Form Selection Information
		Transporter Permits

Underground Injection Control Forms Please send all completed forms to: Permit Section - Bureau of Land Illinois Environmental Protection Agency 1021 North Grand Avenue East #33 Springfield, IL 62794-9276
PDF Size	HTML Size	Description
38KB		Class V Injection Well Codes
23KB		Class V Injection Well Inventory Form
	5KB	Class V Inventory Form Instructions

Used Oil Collection Information Forms Please send all completed forms to: Permit Section - Bureau of Land Illinois Environmental Protection Agency 1021 North Grand Avenue East #33 Springfield, IL 62794-9276
PDF Size	HTML Size	Description
12KB		Used Oil Collection Form
	1KB	Used Oil Collection Form Instructions

Used Tire Forms and Instructions Please send all completed forms to: Used Tire Management Unit Illinois Environmental Protection Agency 1021 North Grand Avenue East Springfield, IL 62794-9276
PDF Size	HTML Size	Description
98KB		Annual Tire Summary Form
44KB		Group Consensual Removal Agreement
43KB		Individual Consensual Removal Agreement
	8KB	Instructions for Notification and Registration of Used and Waste Tire Activity
	7KB	Instructions for Notification of Used and Waste Tire Activity
84KB		Used Tire Notification and Registration Form
59KB		Used Tire Notification Form
152KB		Used Tire Transportation Registration Application Form
	15KB	Used Tire Transporation Registration Application Instructions
52KB		Written Tire Recycling Notice (Posting Required)

Waste Management Forms Please send all completed forms to: Waste Reduction and Compliance Section Bureau of Land Illinois Environmental Protection Agency 1021 N. Grand Avenue East P.O. Box 19276 Springfield, IL 62794-9276
PDF Size	HTML Size	Description
722 KB		Five Year Waste Management Update Form
		Landfill Capacity Recycling Coordinators and Contact Persons Form
		Landfill Capacity Transfer Station Form

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