Forms & Worksheets
Contact us (406-841-5090 or e-mail Janet at jaadolph@mt.gov) for copies in Word format.
* You will need Adobe 7.0 or higher to use online input forms properly. The forms below can be filled out on-line, then printed, signed, notarized and sent to the Petroleum Tank Release Board. You may also save them to your computer if you have Adobe Professional.
In some cases we may request a W-9 (tax ID number verification) form. For a copy of the form, please click here.
| Form Title | Format |
|---|---|
| Application for Petroleum Release Eligibility Use this form to apply for eligibility to receive reimbursement of costs associated with a release from a petroleum storage tank and/or associated piping. |
Updated 9/15/2010 |
| Transfer of Release Eligibility Complete this form to advise the Board a new owner/operator is assuming responsibility for the release. |
Updated 8/18/2010 |
| Application for Voluntary Registration Use this form to determine potential eligibility for reimbursement from the Petroleum Tank Release Cleanup Fund prior to a release. |
Updated 8/18/2010 |
| Assent to Audit Use this form to indicate assent to an audit of time sheets, payroll records, purchase orders, and other documents. Required for payment of claim. |
Updated 4/4/2012 |
|
Claim for Reimbursement–Corrective Action |
Updated 10/19/2011 |
| Claim for Reimbursement–Third Party Instructions and form necessary to file a third party claim. |
Updated 8/19/2010 |
| Designation of Representative Use this form to designate another person to receive reimbursement. |
Updated 2/3/2012 |
| Acknowledgment of Payment Use this form to acknowledge payment of invoice(s). |
Updated 2/3/2012 |
| Owner/Operator's Report of Insurance Use this form to identify insurance information and to subrogate and assign certain rights to the board. |
Updated 12/9/2010 |
| Corrective Action Plan Budget Modification Form -DRAFT Use this form to obtain approval of changes to Corrective Action Plan. |
Updated 3/25/2011 |
| Equipment Policy Acknowledgement Use this form to document remediation equipment at a facility. |
Updated 4/15/2011 |
| Form Title | Format |
|---|---|
| Soil Boring/ Monitoring Well Installation Use this form to provide unit cost for tasks associated with boring and well installation. Updated 4/2/2012. |
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| Groundwater Monitoring and Sampling Use this form to provide unit cost for tasks associated with monitoring and sampling. Updated 4/2/2012. |
|
| Soil Excavation Use this form to provide unit cost for excavation based upon banked yards removed. Updated 4/2/2012. |
| Form Title | Format |
|---|---|
| Aboveground Storage Tank Self-Inspections For use by owners and operators of aboveground storage tank facilities. Updated 11/10/2011. |
AST Checklist
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