UST Forms and Guidance

Form Description (Forms Needed for Registration) Form Number and Link  Form Description
Pre-Installation Notification Form CN-1288 Form required to inform the Division of your intent to install tanks at a new facility
Amended Notification Form CN-1260 Form required to Amend information about the tanks at an existing facility
Buyers Notification Form CN-1392 Form to be filled out and submitted by the buyer of a registered facility
Sellers Change of Ownership Form CN-0911 Form to be filled out by the seller of a registered facility 
Change of Address Form  CN-1383 Form to be filled out and submitted when the address of the owner or the facility is changed
Indicia of Ownership Form CN-1186  
Form Description (Resources needed to close tanks.) Form/Link Instructions

Closure Packet Instructions

Rev. July 2005

Instructions for Closure Packet.

UST System Closure Assessment Guidelines

Rev. Sept. 2006

When closing tanks, complete the "Closure Application".

Submit the application to the appropriate Field Office for approval 30 days prior to closing the UST system.

After tanks are out of the ground or properly closed in place, be sure to file an amended notification form with TN UST.

This stops the automatic billing procedure for annual tank registration.

(Note Corrected values on Table 5 effective April 1, 2007)

Application For Permanent Closure Of Underground Storage Tanks

CN-0928
Rev. July 2005

  

Permanent Closure Report

CN-0927
Rev. Apr. 2007

  

Application To Treat Petroleum Contaminated Soil By Mobile Thermal Treatment

July 1, 2005

  

Application To Treat Petroleum Contaminated Soil By Aeration

July 1, 2005

  

Approved Methods For Analysis Of Soil And Water Samples

LINK

  

Field Office Location Map

LINK

  

TGD-005 Sampling Requirements For Excavated Material

TGD-005
Rev. July 1, 2005

  

TGD-009 Requirements To Treat Petroleum Contaminated Soil Generated From Releases From Underground Storage Tanks

TGD-009
Rev. July 1, 2005

  

TGD-011 Procedures To Determine The Applicable Soil And Ground Water Cleanup Levels During An Underground Storage Tank System Closure

TGD-011
RESCINDED July 1, 2005

  

Chemicals Of Concern

Reference 1

  

Tennessee PAH List

Reference 2

  
Form Description Form/Link Instructions
Compliance Tool Box LINK Latest edition of Compliance Tool Box
UST Owner Compliance Manual LINK  
Tank Tightness Testing Report CN-1601 Tank Tightness Testing Report form can be used for release detection, repair, release investigation, or new installation.
Precision Line Tightness And Leak Detector Test Report CN-1341 Line Tightness & Leak Detector Test that can be used for release detection, repair, release investigation, or new installation.
Impressed Current Cathodic Protection Rectifier Reading Form CN-1282 60-Day Log for Impressed Current Systems
Impressed Current Cathodic Protection Testing Survey CN-1309 3-Year Impressed Current Cathodic Protection Test
Galvanic Cathodic Protection Testing Survey CN-1140 3-Year Galvanic Cathodic Protection Test
Monthly Spill Bucket Inspection Log CN-1286  
Spill Prevention Device Hydrostatic Test Report CN-1366 This form can be used to record hydrostatic testing of spill buckets.
Quarterly Dispenser Inspection Log CN-1287  
Monthly Electronic Interstitial Monitoring Report CN-1340 This form is used for Interstitial Monitoring release detection.
Annual Electronic Interstitial Monitoring Test Report CN-1339  
Manual Tank Gauging Monthly Report CN-1367 This form can be used to record monthly Manual Tank Gauging Reports.
Preparing For A Compliance Inspection LINK  
Ethanol Equipment Compatibility Checklist CN-1285
(Rev. Oct. 2021)		  
Statement Of Compatibility CN-1283 This form is used for indicating that the UST system components will be compatible with the product stored.
Visual Inspection For Incompatible Dispenser Components CN-1284 This form is used for recording daily visual inspections of incompatible dispenser components.
Monthly/Annual Facility Walkthrough Inspection Form CN-2544 This form is used to document monthly or annual walkthrough inspections required under rule 0400-18-01-.02(8).
Overfill Inspection Form CN-2584 Test procedure to ensure USTs cannot be overfilled (exceeding regulatory requirements).
Annual ATG Operability Test Form CN-2624 This form can be used to record the annual ATG operability test results.
Low Level Hydrostatic Sump Testing Form CN-2644  
Containment Sump Integrity Hydrostatic Test Report CN-2664  

The Division began development of a Standardized Inspection Manual in early 2009 in order to provide effective assistance to our regulated community and to insure consistency of our inspection program statewide. In addition, previously issued Compliance Guidance Documents required much needed updating to provide the necessary technical information for inspectors, the regulated community and their service providers on how to comply with requirements. After draft developments were complete in 2011, the Division sought feedback from various stakeholders including two separate mass mailings to all registered tank owners over a two year period. Service providers also provided valued feedback. The Division continued stakeholder meetings over the past four years incorporating suggestions to the manual and developing additional outreach materials for the regulated community. We are grateful to all who contributed to improve our final product. The manual has now been finalized and is effective October 1, 2015.

The manual is intended to be a standard operating procedure and helpful resource for Division inspectors and includes a step by step process to help them understand what they should look for at each facility as well as standard policies for employees. Technical Chapters of every release detection (RD) method and release prevention requirement provide more detail on the types of equipment and related records as well as photographs illustrating what is routinely found at UST facilities. These chapters also discuss specific manufacturers’ requirements that are referenced in the Division regulations. The manual also includes previously developed as well as some new standardized fillable forms for several RD methods as well as required testing that include the minimum required information.

Form Description

Form/Link

Instructions

Reimbursement Guidance Documents

RGD-002
(Rev. April 15, 2014)

RGD-002
(Effective 05/20/2022)

 

Task Cost Sheets

RGD-002

RGD-002 - Attachement I
(Effective 05/20/2022)

 

Blank Signature Pages For Electronic Reimbursement Applications

CN-0923

See Reimbursement Guidance Documents

Application For Fund Eligibility

CN-0943
(Rev. Sep. 2021)

Application for Fund Eligibility Deadline –
The UST Act establishes a deadline for tank owners, tank operators or petroleum site owners to file an Application for Fund Eligibility.

If the application form is not received by the UST Division by the deadline established by law, the release WILL NOT BE FUND ELIGIBLE. The application must be received:
Within 60 days of a release which was identified in any manner other than the process for confirmation of a suspected release in the regulations;

or

Within 90 days of the discovery of evidence of a suspected release which is subsequently confirmed in accordance with the regulatory requirements.

NOTE: The 90 day deadline applies even if confirmation of a release does not occur within 90 days of the discovery of evidence of a suspected release.

An application should be filed as soon as possible after a release is suspected, even if all the confirmation steps have not been taken.

 

Tax Identification Number 

 

 Federal W-9 For to be submitted to the Division so that eligible costs can be reimbursed.  

Cost Database forSubmittal - New

32 Bit Access
64 Bit Access

Use this version of the cost database when no previous data exist.
Cost Database for Submittal - Existing 32 Bit Access
64 Bit Access		 Use this version of the cost database to transfer data

Approved Corrective Action Contractor List

CAC List

Revised December 9, 2021

Form Description

Form/Link

Corrective Action Contractor Information

  
 

Approved Corrective Action Contractor List (Revised December 9, 2021)

CAC List
 

Application for Approved Corrective Action Contractor Status

CN-0945
(Rev. Feb. 2017)

Guidelines, Forms, And Technical Guidance Documents

  
 

Site Check Report Guidelines

Aug. 1996
 

Environmental Assessment Guidelines

Sept. 2006
 

Initial Site Characterization Guidelines - Parts A and B

LINK
 

Initial Response and Hazard Management Report Guidelines - Part A

Sept. 2006
 

Initial Site Characterization Report Guidelines

Sept. 2006
 

Corrective Action Plan Guidelines

Jan. 2010
 

Corrective Action Plan Cost Sheets

Link
 

Corrective Action System Figures - 2010

  
   

TDEC Air Lift CAS Figure Package

LINK
   

TDEC Groundwater Pump CAS Figure Package

LINK
   

TDEC Standard CAS Figure Package

LINK

Corrective Action System Workbook

LINK
Corrective Action System Deactivation Checklist Link

Hazard Notification Report Form

CN-1259

Chemicals Of Concern

Reference 1

Tennessee PAH List

Reference 2

Form Description

Link

Approved Corrective Action Contractor List (Revised December 9, 2021)

CAC List

Cathodic Protection Testers serving Tennessee

August 2019

Corrosion Protection Experts serving Tennessee (Revised May 24, 2021)

 CP Experts list

New lodging and Per Diem rates are effective as of October 01, 2020. Please use the link below and see page 13 for the latest rates.

TN Travel Policy 8

The Division's new GIS Dataviewer is now online. We are consistently and constantly updating our data. When data is updated on our systems, it takes up to 48 hours to appear in the dataviewer. The dataviewer can be found at : https://tdeconline.tn.gov/USTActiveInactive_public/.