CSRR Forms Library

The SRRA Forms Page is in four sections: 1) NJDEP Online Services, 2) RAO, Receptor Evaluation and CEA Forms, and 3) Remedial Action Permit Forms, and 4) General Forms.

NJDEP Online Forms

This section contains all the forms that are available for submission using NJDEP Online, the CID and authorization form required to be completed and uploaded in some submissions.

RAO, Receptor Evaluation and CEA Forms

This section consolidates the RAO forms and common form submittals that accompany the remedial phase reports. The common information fields of these forms have been
moved to the “Cover/Certification Form” to eliminate redundancy when submitting multiple remedial phase forms at one time.

General

This section contains the remaining forms which do not fit into the above two sections.

Note several forms have been renamed as follows:

  • Name and Address Change Reporting Form is now “Site and Contact Information Update Form;”
  • De Minimis Quantity Exemption Application Form is now “ISRA De Minimis Quantity Exemption Application Form;”
  • General Information Notification Form is now “ISRA General Information Notification Form;”
  • Remediation Certification Form is now “ISRA Remediation Certification Form;” and
  • Remedial Action Permit Transfer/Change of Ownership Application is now the “Remedial Action Permit Transfer/Change of Property Ownership Application”.

Unless otherwise noted in Instructions, all form submittals are to be directed to the following address:

Bureau of Case Assignment & Initial Notice
Contaminated Site Remediation & Redevelopment
NJ Department of Environmental Protection
401-05H
PO Box 420
Trenton, NJ 08625-0420

Forms without payments or online services can also be emailed to srp_submissions@njdepwptest.net.

For forms related to RCRA, CERCLA, Federal Facilities, and Traditional Oversight, and Direct Oversight.

Related Topics

Disclaimer:
Users of this information should not consider these materials the sole source of information sufficient in itself to dictate any outcome or decision on the remediation of a contaminated site but should refer to the Department’s rules and guidance provided on SRP’s web site.

CSRR Forms

NJDEP Online Services Download Version & Date Changes Since Last Version Rule
Annual Remediation Fee Reporting
Pay/Update Online (Requires Login, Service must be Certified by an LSRP)
Instructions [pdf] 1.4 – 6/15/2015 Update Log 7:26C-4.3 [pdf]
Case Inventory Document Worksheet Spreadsheet [xlsm] 1.5.1 – 2/4/2021 Update Log
Case Inventory Document Instructions Instructions [pdf] 1.6 – 1/26/2023 Update Log
Confirmed Discharge Notification (CDN)
Submit Confirmed Discharge Notification Online. (Requires Login)
FAQs [pdf] Instructions [pdf] 1.6 – 10/15/2024 Update Log
General Information Notice (GIN)
Submit General Information Notice Online. (Requires Login)
FAQs [pdf] Instructions [pdf] 1.1 – 12/4/2018 Update Log
Authorization Form To Submit A Confirmed Discharge Notification (CDN)
or General Information Notice (GIN) through NJDEP Online
Form [pdf] Instructions [pdf] 1.0 – 10/11/2017
LSRP Notification of Retention or Dismissal
Submit LSRP Notification Online. (Requires Login, Service must be Certified by an LSRP)
Instructions [pdf] 1.3 – 11/22/2021 Update Log 7:26C-2.3 [pdf]
Oversight Services
Direct Oversight
Submit Direct Oversight Documents online (Requires Login)
Instructions [pdf] 1.0 – 7/26/2023 Update Log
Traditional Oversight
Submit CERCLA, RCRA, DOD, DOE, EPA, or Chrome Submissions Online (Requires Login)
Instructions [pdf] 1.0 – 7/26/2023 Update Log
Public Notification and Outreach Service
Submit Public Notification and Outreach form Online. (Requires Login, Service must be Certified by an LSRP)
Instructions [pdf] 1.2 – 1/18/2022 Update Log
Public Notification and Outreach Form Form [pdf] Instructions [pdf] 2.3 – 9/1/2020 Update Log
Child Care PA, Clean PASI, or Clean SI Standalone Report Submissions
Submit Child Care PA, Clean PASI, or Clean SI Standalone Report Online. (Requires Login, Service must be Certified by an LSRP)
Instructions [pdf] 1.1 – 8/17/2022 Update Log
Preliminary Assessment Report Service
Submit PA Online. (Requires Login, Service must be Certified by an LSRP)
FAQs [pdf] Instructions [pdf] 1.3 – 6/7/2022 Update Log
Preliminary Assessment/Site Investigation Report Service
Submit PA/SI Online. (Requires Login, Service must be Certified by an LSRP)
FAQs [pdf] Instructions [pdf] 1.2 – 1/15/2020 Update Log
Site Investigation Report Service
Submit SI Online. (Requires Login, Service must be Certified by an LSRP)
FAQs [pdf] Instructions [pdf] 1.2 – 1/15/2020 Update Log
Remedial Investigation Report Online Service
Submit RIR Online. (Requires Login, Service must be certified by an LSRP)
FAQs [pdf] Instructions [pdf] 1.6 – 2/22/2022 Update Log 7:26E-4.9 [pdf]
Remedial Action Workplan Online Service
Submit RAW Online. (Requires Login, Service must be certified by an LSRP)
FAQs [pdf] Instructions [pdf] 1.4 – 2/22/2022 Update Log
Remedial Action Report Online Service
Submit RAR Online. (Requires Login, Service must be certified by an LSRP)
FAQs [pdf]
FAQs & Flow Charts [pdf]
Instructions [pdf] 1.5 – 2/22/2022 Update Log
Response Action Outcome Online Service
Submit RAO Online. (Requires Login, Service must be certified by an LSRP)
FAQs [pdf] Instructions [pdf] 1.2 – 6/7/2022 Update Log
Authorization To Submit a Report / Form through NJDEP Online
Note: This form replaces the “Authorization To Submit a Remedial Phase Report through NJDEP Online”.
Form [pdf] Instructions [pdf] 1.4 – 9/17/2024 Update Log
Underground Storage Tank (UST) Facility Certification Questionnaire UST Forms Page
Underground Storage Tank Notice of Intent to Close
Submit UST NOI Online. (Requires Login, Service must be certified by an LSRP)
Instructions [pdf] 1.1 – 10/15/2024 Update Log 7:14B-9.2 [pdf]
RAO, Receptor Evaluation and CEA Forms Download Version & Date Changes Since Last Version Rule
Cover/Certification Form
(Must be submitted with the forms listed below unless submitted online)
Form [pdf] Instructions [pdf] 1.1 – 9/17/2018 Update Log
Response Action Outcome form Form [pdf] Instructions [pdf] 3.4 – 11/15/2019 Update Log 7:26C-6.2 [pdf]
Response Action Outcome Notices Word Document [docx]
Model Response Action Outcome (Appendix D for the ARRCS Rule) Model Document [docx]
Receptor Evaluation form Form [pdf]

FAQs [pdf]

Instructions [pdf] 2.5 – 6/28/2021 Update Log 7:26E-1.12 [pdf]
Well Search Spreadsheet Spreadsheet [xls] Instructions [pdf] 1.3 – 3/22/2012 Update Log
CEA/Well Restriction Area (WRA) Fact Sheet form Form [pdf] Instructions [pdf] 1.9 – 9/18/2018 Update Log 7:26C-7.3 [pdf]
Remedial Action Permit Forms Download Version & Date Changes Since Last Version Rule
Financial Assurance (FA)
Remediation Trust Fund Agreement for FA – Please N.J.A.C. 7:26C-5.4 for specific requirements Remediation Trust Fund Agreement for FA [doc] N.J.A.C. 7:26C-5.4 [pdf]
Line of Credit Agreement for FA – Please N.J.A.C. 7:26C-5.6 for specific requirements. Line of Credit Agreement for FA [doc] N.J.A.C. 7:26C-5.6 [pdf]
Letter of Credit for FA – Please N.J.A.C. 7:26C-5.7 for specific requirements. Letter of Credit for FA [doc] N.J.A.C. 7:26C-5.7 [pdf]
Environmental Insurance Policy – Please DEP’s regulatory requirements at N.J.A.C. 7:26C-5.5. N.J.A.C. 7:26C-5.5 [pdf]
Surety Bond – Please N.J.S.A. 58:10B-3.i for specific requirements. Surety Bond [docx]
Ground Water Monitoring Plan Spreadsheet for Ground Water Remedial Action Permit
You may have to reset your macros security in Excel before it will open/work properly. To reset: In a
blank spreadsheet, go to TOOLS, MACROS, SECURITY. Set to MEDIUM. After that, open the spreadsheet,
and select the button that says – Enable Macros.
Spreadsheet [xlsm] Instructions [pdf] 1.1 – 12/4/2023 Update Log
Model Documents
Model Deed Notice (Appendix B of the ARRCS Rule) Model Document [docx] 5/8/2018 Update Log 7:26C-7.2 [pdf]
Model Termination of Deed Notice (Appendix C of the ARRCS Rule) Model Document [doc] 5/8/2018 Update Log 7:26C-7.13 [pdf]
Model Notice in Lieu of Deed Notice Example (Appendix 2 of the Soil RAP Guidance document) Model Document [docx]
Sample Notification Letter to Meet Requirements of N.J.A.C. 7:26C-7.2(b)2i (Appendix 3 of the Soil RAP Guidance document) Model Document [docx]
Resolution Concerning Notice in Lieu of Deed Notice Example (Appendix 4 of the Soil RAP Guidance document) Model Document [docx]
Written Agreement Concerning Notice in Lieu of Deed Notice Example (Appendix 5 of the Soil RAP Guidance document) Model Document [docx]
Model Table for Historic Ground Water Sampling Results by Monitoring Well (Appendix 1 of the Ground Water RAP Guidance document) Model Document [xlsx]
Remedial Action Permit Applications FAQs [pdf] 1.0 – 6/2023
Remedial Action Permit Transfer/Change of Property Ownership Application
(Name change. Was “Remedial Action Permit Transfer/Change of Property Ownership Application and Contact Information Changes”)
Form [pdf] Instructions [pdf] 4.0 – 11/18/2024 Update Log 7:26C-7.11 [pdf]
Remedial Action Permit Initial Application – Ground Water

LSRP Supplemental Certification For Initial Ground Water Remedial Action Permit (RAP) Application [pdf]
1.2 – 12/18/2024

Prioritized Initial Remedial Action Permit (RAP) Application Addendum [pdf] 1.0 – 6/29/2023

Notice of Incomplete (NOI) Initial Ground Water RAP Application Checklist [pdf] 1.0 – 11/2024
(Note: The checklist should not be included with the RAP Application and RAR submitted to CSRR.)

Form [pdf] Instructions [pdf]

Instructions [pdf]

Instructions [pdf]

1.8 – 6/3/2024 Update Log

Update Log

Remedial Action Permit Modification Application – Ground Water Form [pdf] Instructions [pdf] 1.8 – 6/3/2024 Update Log
Remedial Action Permit Termination Application – Ground Water Form [pdf] Instructions [pdf] 1.7 – 6/3/2024 Update Log
Remedial Action Permit Initial Application – Soil

LSRP Supplemental Certification For Initial Soil Remedial Action Permit (RAP) Application [pdf] 1.2 – 2/15/2024

Prioritized Initial Remedial Action Permit (RAP) Application Addendum [pdf] 1.0 – 6/29/2023

Notice of Incomplete (NOI) Initial Soil RAP Application Checklist [pdf] 1.0 – 11/2024
(Note: The checklist should not be included with the RAP Application and RAR submitted to CSRR.)

Form [pdf] Instructions [pdf]

Instructions [pdf]

Instructions [pdf]

1.8 – 6/3/2024 Update Log

Update Log

Remedial Action Permit Modification Application – Soil Form [pdf] Instructions [pdf] 1.8 – 6/3/2024 Update Log
Remedial Action Permit Termination Application – Soil Form [pdf] Instructions [pdf] 1.6 – 6/3/2024 Update Log
Remedial Action Protectiveness / Biennial Certification Form – Ground Water
(Name change. Was “Remedial Action Protectiveness Certification Form – Ground Water”)
Form [pdf] Instructions [pdf] 2.3 – 6/3/2024 Update Log 7:26C-7.7 [pdf]
Remedial Action Protectiveness / Biennial Certification Form – Soil
(Name change. Was “Remedial Action Protectiveness Certification Form – Soils”)
Form [pdf] Instructions [pdf] 2.3 – 6/3/2024 Update Log 7:26C-7.7 [pdf]
Remedial Action Permit Contact Information Change
(Name change. Was “Remedial Action Permit Transfer/Change of Property Ownership Application and Contact Information Changes”)
Form [pdf] Instructions [pdf] 1.2 – 1/27/2023 Update Log
Termination of Deed Notice Form Form [pdf] Instructions [pdf] 1.2 – 6/2/2022 Update Log
General Forms Download Version & Date Changes Since Last Version Rule
7.5 Percent Cost of Remediation Form Form [pdf] Instructions [pdf] 1.1 – 9/17/2018 Update Log 7:26C-4.10 [pdf]
Alternative or New Remediation Standard and/or Screening Level Application form
(Name change. Was “Alternative Soil Remediation Standard and/or Screening Level Application form”)
Form [pdf] Instructions [pdf] 2.4 – 5/3/2021 Update Log 7:26D-7.4 [pdf]
Remediation Standard Notification Spreadsheet SpreadSheet [xls] 1.1 – 5/3/2021 Update Log
Alternative Remedy/Remedial Action Pre-Approval Form Form [pdf] Instructions [pdf] 1.5 – 9/17/2018 Update Log 7:26C-5.3(c) [pdf]
Brownfield Development Area Application Form
Note: See the Brownfield Development Area (BDA) Designation page for more information.
Form [pdf] Instructions [pdf] 1.0 – 1/5/2024
Case Creation Request form
Note: This form is for filing a (CDN) for Historic Fill only, or creating a case for Madden Subject Educational Facility, or creating a case where there is no Statutory or Regulatory Requirement, but remediation conducted for the purpose of obtaining a Response Action Outcome (RAO).
Form [pdf] Instructions [pdf] 1.0 – 12/3/2018 7:26C-1.7 [pdf]
Child Care Center/Educational Facility Remediation Form Form [pdf] Instructions [pdf] 1.2 – 5/26/2020 Update Log P.L. 2007 Chapter 1 [pdf]
Confidentiality Request Form Form [pdf] Instructions [pdf] 1.2 – 4/1/2015 Update Log 7:26C-15.3 [pdf]
Developer Certification (Appendix A for the ARRCS Rule) Model Document [doc] 7:26C-4.7 [pdf]
Discharge to Ground Water Permit by Rule Authorization Request Form [pdf] Instructions [pdf] 1.2 – 9/17/2018 Update Log 7:26E-5.6 [pdf]
Exemption from Spill Act Liability Certification Form [pdf] Instructions [pdf] 1.1 – 4/2/2013 Update Log 7:26C-1.4(f) [pdf]
Full Laboratory Data Deliverables form Form [pdf] Instructions [pdf] 1.8 – 8/26/2021 Update Log 7:26E-1.11, 14 & 15 [pdf]
Hazardous Discharge Site Remediation Fund Application form
Note: the CSRR Financial Assistance HDSRF page for more information & guidance.
Form [pdf] Instructions [pdf] 1.5 – 9/17/2018 Update Log 7:26C-11.2 [pdf]
HDSRF Child Care Facility Grant Application Form [pdf] Instructions [pdf] 1.2 – 10/24/2016 Update Log 7:26C-11.2 [pdf]
Historically Applied Pesticides Deferral Request Form [pdf] Instructions [pdf] 1.2 – 11/21/2019 Update Log
IEC Response Action form Form [pdf] Instructions [pdf] 1.8 – 1/6/2023 Update Log 7:26E-1.11 [pdf]
IEC – Direct Contact Spreadsheet Spreadsheet [xls] 1.1 – 3/26/2015 Update Log
IEC – Potable Water Spreadsheet Spreadsheet [xls] 1.3 – 3/26/2015 Update Log
IEC/VC – Vapor Intrusion Spreadsheet Spreadsheet [xls] 1.3 – 3/26/2015 Update Log
IEC Monitoring and Maintenance Checklist Form [pdf] 1.1 – 3/16/2018 Update Log
ISRA Alternate Compliance Option Application Form [pdf] Instructions [pdf] 2.0 – 11/10/2020 Update Log 7:26B-5 [pdf]
ISRA Certificate of Limited Conveyance Application Form [pdf] Instructions [pdf] 1.1 – 7/24/2012 Update Log 7:26B-5.7 [pdf]
ISRA De Minimis Quantity Exemption Affidavit Application
(Formerly De Minimus Quantity Exemption Application)
Form [pdf] Instructions [pdf] 1.6 – 8/7/2019 Update Log 7:26B-5.9 [pdf]
ISRA General Information Notice for Confidential Submissions Only
Note: Submit along with Confidentiality Form, all other GINs use online service above.
Form [pdf] Instructions [pdf] 2.0 – 12/3/2018 Update Log 7:26B-3.2 [pdf]
ISRA Remediation Certification form
(Formerly Remediation Certification form)
Form [pdf] Instructions [pdf] 2.0 – 11/21/2022 Update Log 7:26B-3.3 [pdf]
Linear Construction Project Form [pdf] Instructions [pdf] 1.1 – 9/17/2018 Update Log 7:26C-16.2(a)2 [pdf]
LNAPL Free Product Reporting Form Form [pdf] Instructions [pdf] 1.7 – 9/17/2018 Update Log 7:26E-1.10(b) [pdf]
Monitoring Well Certification Form A – As-Built Certification Form [pdf] Instructions [pdf] 1.0 – 9/7/2011 Update Log 7:26E-1.6 [pdf]
Monitoring Well Certification Form B – Location Certification Form [pdf] Instructions [pdf] 1.3 – 2/26/2013 Update Log 7:26E-1.6 [pdf]
Notice of Failure to Comply with a Mandatory or Expedited Site-specific Remediation Timeframe Form [pdf] Instructions [pdf] 1.0 – 4/27/2016 Update Log 7:26I-6.8(c) [pdf]
Out of Service Extension Request for an Underground Storage Tank System
(Name change. Was “Underground Storage Tank System Closure Notification / Extension Request form”)
Form [pdf] Instructions [pdf] 1.5 – 9/17/2018 Update Log 7:14B-9.1 [pdf]
Petroleum UST Fund Application (Regulated) (Closes 6/30/2010) Form [pdf] Instructions [pdf] 1.2 – 9/17/2018 Update Log 7:26C-12.2
Petroleum UST Fund Application (Unregulated) (Including Residential Heating Oil Tanks) Form [pdf] Instructions [pdf] 1.2 – 9/17/2018 Update Log 7:26C-12.2 [pdf]
Project Summary Sheet Spreadsheet
Note: the CSRR Financial Assistance Petroleum UST Fund page for more information & guidance.
Spreadsheet [xls] 1.0
Pre-Purchase Administrative Consent Order Certification Form [pdf] Instructions [pdf] 1.0 – 9/2/2022 Update Log 7:26C-3.2 [pdf]
Remedial Timeframe Notification Form [pdf] Instructions [pdf] 1.3 – 9/17/2018 Update Log 7:26C-3.2 [pdf]
Remediation Cost Review and RFS-FA Form Form [pdf] Instructions [pdf] 2.2 – 9/23/2020 Update Log 7:26C-5 [pdf]
RFS/FA Model Financial Mechanism Language RFS Guide Page
Self Guarantee Application Form [pdf] Instructions [pdf] 1.3 – 6/12/2014 Update Log 7:26C-5 [pdf]
Site and Contact Information Update Form
(Name change. Was “Name and Address Change Reporting” form)
Form [pdf] Instructions [pdf] 1.3 – 10/18/2017 Update Log
Technical Assistance Grant form
the Guidance for Technical Assistance Grants [pdf] for more information.
Form [pdf] Instructions [pdf] 1.4 – 9/17/2018 Update Log 7:26C-10.5 [pdf]
Underground Storage Tank Forms UST Forms Page
Vapor Concern (VC) Response Action Form Form [pdf] Instructions [pdf] 1.5 – 1/6/2023 Update Log 7:26C-1.15 [pdf]
Variance Identification Form Form [pdf]