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Pat Quinn, Governor
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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
 

Electronic Waste Recycling

PDF Size Description
35KB Collector Total Weight Collected
35KB Covered Electronic Products Manufacturer's Recycler Information
38KB Covered Electronic Products Manufacturer's Sales Report
40KB Manufacturer's Registration Form
34KB Manufacturer Total Weight Collected
34KB Processor and Collector Registration Form
  

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
  Illinois Generator Nonhazardous Special Waste Annual Report for Waste Shipped Out-of-State
  Facility TSDR Nonhazardous Special Waste Annual Report Forms and Instructions
  2013 Hazardous Waste Report Forms and Instructions
  List of special waste haulers
  Annual Generator Special Waste Recertification for Disposal of Special Waste
  Special Waste Preacceptance Form
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
  Notification of Universal Lamp Crushing Activity
       

Landfill Operator Certification Forms

PDF Size Description
  New Application
  Renewal Application
 

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
     

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
   

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
    Five Year Waste Management Update Form
    Landfill Capacity Certification Online Form
    Landfill Capacity Certification Online Form Instructions
    Local Solid Waste Fees Form
    Permitted Compost Site Annual Report Form
    Solid Waste Management Fees Fact Sheet
    State Solid Waste Management Fees Forms
    State Solid Waste Management Fees Forms Instructions

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