Illinois Environmental Protection Agency  
www.epa.state.il.us

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

  Description
Instructions for Completing Online Forms
Municipal Brownfields Redevelopment Grant Amendment Request Form
Municipal Brownfields Redevelopment Grant Amendment Request Instructions
Municipal Brownfields Redevelopment Grant Application Checklist
Municipal Brownfields Redevelopment Grant Application Package
Municipal Brownfields Redevelopment Grant Match Funding Certification
Municipal Brownfields Redevelopment Grant Matching Funds Time Report Example
Municipal Brownfields Redevelopment Grant Quarterly Report Form
Municipal Brownfields Redevelopment Grant Quarterly Report Form Instructions
Municipal Brownfields Redevelopment Grant Reimbursement Request Form 
Municipal Brownfields Redevelopment Grant Reimbursement Request Instructions
Municipal Brownfields Redevelopment Loan Application Package
Site Remediation Program Billing and Invoice Procedures
Site Remediation Program Forms
Site Remediation Program Assessment of Advance Partial Payment Form (DRM-3)
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

  Description
Collector Total Weight Collected
Covered Electronic Products Manufacturer's Recycler Information
Covered Electronic Products Manufacturer's Sales Report
Manufacturer's Registration Form
Manufacturer Total Weight Collected
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

  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
Certificate of Exemption for Automotive Repair and Auto Body Shops
Illinois EPA Inventory Application
New Manifest Information (includes links to new USEPA-required manifest forms)
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

  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
  Description
Assignment of UST Fund Payments
Budget Forms
Election to Proceed under the Site Remediation Program
Technical Forms Main Page
Model Documents
  Description
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

  Description
Manifest Form Selection Information
Manifest Online Purchases (by Credit Card)
New Uniform Hazardous Waste Manifest Forms Information
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
   
Potentially Infectious Medical Waste (PIMW) 
  PIMW Monthly Report
  PIMW Quarterly Report

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

  Description
DRM-1 Instructions and Form
DRM-2 Instructions and Form
DRM-3 Instructions and Form
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

  Description
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

  Description
Class V Injection Well Codes
Class V Injection Well Inventory Form
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

  Description
Used Oil Collection Form
Used Oil Collection Form Instructions
   

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