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Part 201 and 213 Program Forms and Documents

application form
Environment, Great Lakes, and Energy

Part 201 and 213 Program Forms and Documents

This webpage provides cleanup program information for Part 201 and Part 213.  If you have any questions on the application of these documents to site specific conditions, please contact the Remediation and Redevelopment Division District Map and Offices covering your site.

 

Form No.

Title (word)

On Line Fillable Form

PDF

EQP3801 Notice of On-Site Work Activity Fax Transmittal Electronic Submittal Yes
EQP3853 Notice of Corrective Action Under - Part 213   Yes
EQP3854 Declaration of Restrictive Covenant - Part 213   Yes
EQP3887 Notice of Aesthetic Impact - Part 213   Yes
EQP3900 Notice of Aesthetic Impact - Part 201   Yes
EQP4000 Final Assessment Report Cover Sheet   Yes
EQP4001 Supplemental Information Cover Sheet - Part 213   Yes
EQP4002 Initial Assessment Report Cover Sheet - Part 213   Yes
EQP4003 Notice to Impacted Parties of Corrective Action Part 213   Yes
EQP4004 Closure Conditional Approval Documentation - Part 213   Yes
EQP4005 Final Assessment Report Conditional Approval Documentation - Part 213   Yes
EQP4006 Initial Assessment Report Table of Contents Form   Yes
EQP4007 Final Assessment Report Table of Contents Form   Yes
EQP4008 Closure Report Table of Contents Form   Yes
EQP4023 Notice to LUGS of Land Use Restrictions   Yes
EQP4025 Baseline Environmental Assessment Submittal Form   Yes
EQP4028 Request for EGLE Review of Response Activity Plan   Yes
EQP4029 Environmental Consultant Affidavit for No Further Action Report   Yes
EQP4030 Request for EGLE Review of No Further Action (NFA) Report   Yes
EQP4031 Affidavit of Person Submitting a No Further Action Report   Yes
EQP4380 Response Activity Plan to Comply with 7a(1)(b)   Yes
EQP4400 Request for Certificate of Completion from EGLE - Part 201   Yes
EQP4402 Documentation of Due Care Compliance Submittal Form   Yes
EQP4420 Response Activity Review Panel Petition Cover Sheet   Yes
EQP4452 Closure Report Cover Sheet Form   Yes
EQP4460 Certificate Of Deposit Or Time Deposit Account Part 213   Yes
EQP4461 Escrow Agreement - Part 213   Yes
EQP4462 Performance Bond - Part 213   Yes
EQP4463 Trust Agreement - Part 213   Yes
EQP4464 Financial Test and Financial Test/Corporate Guarantee - Part 213   Yes
EQP4465 Letter of Credit - Part 213   Yes
EQP4467 Site-Specific Volatilization to Indoor Air Criteria and Site-Specific Target Levels Request    
EQP4469 Leaking Underground Storage Tank Site Classification Form   Yes
EQP4476 Notice of Discarded or Abandoned Containers    
EQP4482 Notice of Migration of Contamination   Yes
EQP4483 Request For Mixing Zone Based GSI Criteria   Yes
EQP4506 Public Highway Institutional Control   Yes
EQP4507 Certificate of Deposit - Part 201   Yes
EQP4508 Declaration of Restrictive Covenant Part 201   Yes
EQP4509 Escrow Agreement -Part 201   Yes
EQP4510 Financial Test Corporate Guarantee   Yes
EQP4511 Letter of Credit   Yes
EQP4514 Postclosure Agreement   Yes