The forms below can be filled out on-line, saved, printed, signed, notarized and sent to the Petroleum Tank Release Compensation Board. A W-9 may be necessary for processing some of our forms or for updating our data base - click here for a blank W-9 form - submit to Petro Staff, Garnet Pirre, via hard copy only.
If you would like to receive payment by direct deposit, please us this link for the most up-to-date form: Electronic Funds Transfer - please submit to Fiscal Services at Department of Environmental Quality, PO Box 200901, Helena, MT 59620-0901
If you're experiencing difficulty with our fillable forms in Google Chrome - please try using another browser, such as Internet Explorer.
Forms
Form Title
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Format
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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.
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Transfer of Release Eligibility
Complete this form to advise the Board a new owner/operator is assuming responsibility for the release.
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Application for Voluntary Registration
Use this form to determine potential eligibility for reimbursement from the Petroleum Tank Release Cleanup Fund prior to a release.
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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.
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Claim for Reimbursement–Corrective Action
Instructions and form necessary to file a claim for reimbursement.
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Claim for Reimbursement–Third Party
Instructions and form necessary to file a third party claim.
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Designation of Representative
Use this form to designate another person to receive reimbursement.
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Acknowledgment of Payment
Use this form to acknowledge payment of invoice(s).
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Owner/Operator's Report of Insurance
Use this form to identify insurance information and to subrogate and assign certain rights to the board.
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Corrective Action Plan Modification Form
Use this form to obtain approval of changes to Corrective Action Plan.
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Equipment Policy Acknowledgement
Use this form to document disposition remediation equipment at a facility.
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Multiple Funding Source Template
Use this Microsoft Excel spreadsheet for allocation of costs among funding sources
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Request for Allocation of Costs to Co-Pay
Use this form to allocate corrective action costs from grants or insurance payments toward copay.
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- Here is a link of interest for your information and use.
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DNRC Well Abandonment Form
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Unit Cost Worksheets
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Form Title
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Format
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Soil Boring/ Monitoring Well Installation
Use this form to provide unit cost for tasks associated with boring and well installation.
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Groundwater Monitoring and Sampling
Use this tool, in Microsoft Excel Format, to provide more specific costs associated with groundwater monitoring.
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Bulk Soil Excavation
Use this bulk estimator, in Microsoft Excel format, to provide unit costs for excavation based upon banked cubic yards (BCY) removed for multiple bulk categories.
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Well Abandonment Form (WAF) -
Use this well abandonment form, in Microsoft Excel format, to provide unit costs for tasks associated with abandoning monitoring wells..
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Checklists
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Form Title
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Format
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Aboveground Storage Tank Self-Inspections
For use by owners and operators of aboveground storage tank facilities.
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