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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

EQP3801 Notice of On-Site Work Activity Fax Transmittal (.docx) or Electronic Submittal
EQP3801 Notice of On-Site Work Activity Fax Transmittal (.pdf)
EQP3853 Notice of Corrective Action Under - Part 213 (.docx)
EQP3853 Notice of Corrective Action Under - Part 213 (.pdf)
EQP3854 Declaration of Restrictive Covenant - Part 213 (.docx)
EQP3854 Declaration of Restrictive Covenant - Part 213 (.pdf)
EQP3887 Notice of Aesthetic Impact - Part 213 (.docx)
EQP3887 Notice of Aesthetic Impact - Part 213 (.pdf)
EQP3900 Notice of Aesthetic Impact - Part 201 (.docx)
EQP3900 Notice of Aesthetic Impact - Part 201 (.pdf)
EQP4000 Final Assessment Report Cover Sheet (.docx)
EQP4000 Final Assessment Report Cover Sheet (.pdf)
EQP4001 Supplemental Information Cover Sheet - Part 213 (.docx)
EQP4001 Supplemental Information Cover Sheet - Part 213 (.pdf)
EQP4002 Initial Assessment Report Cover Sheet - Part 213 (.pdf)
EQP4003 Notice to Impacted Parties of Corrective Action Part 213 (.pdf)
EQP4004 Closure Conditional Approval Documentation - Part 213 (.pdf)
EQP4005 Final Assessment Report Conditional Approval Documentation - Part 213 (.pdf)
EQP4006 Initial Assessment Report Table of Contents Form (.pdf)
EQP4007 Final Assessment Report Table of Contents Form (.pdf)
EQP4008 Closure Report Table of Contents Form (.pdf)
EQP4023 Notice to LUGS of Land Use Restrictions (.docx)
EQP4023 Notice to LUGS of Land Use Restrictions (.pdf)
EQP4025 Baseline Environmental Assessment Submittal Form (.docx)
EQP4025 Baseline Environmental Assessment Submittal Form (.pdf)
EQP4028 Request for EGLE Review of Response Activity Plan (.docx)
EQP4028 Request for EGLE Review of Response Activity Plan (.pdf)
EQP4029 Environmental Consultant Affidavit for No Further Action Report (.docx)
EQP4029 Environmental Consultant Affidavit for No Further Action Report (.pdf)
EQP4030 Request for EGLE Review of No Further Action (NFA) Report (.docx)
EQP4030 Request for EGLE Review of No Further Action (NFA) Report (.pdf)
EQP4031 Affidavit of Person Submitting a No Further Action Report (.docx)
EQP4031 Affidavit of Person Submitting a No Further Action Report (.pdf)
EQP4032 RIDE Secondary Certification Authorization (.pdf)
EQP4380 Response Activity Plan to Comply with 7a(1)(b) (.docx)
EQP4380 Response Activity Plan to Comply with 7a(1)(b) (.pdf)
EQP4400 Request for Certificate of Completion from EGLE - Part 201 (.docx)
EQP4400 Request for Certificate of Completion from EGLE - Part 201 (.pdf)
EQP4402 Documentation of Due Care Compliance Submittal Form (.docx)
EQP4402 Documentation of Due Care Compliance Submittal Form (.pdf)
EQP4420 Response Activity Review Panel Petition Cover Sheet (.docx)
EQP4420 Response Activity Review Panel Petition Cover Sheet (.pdf)
EQP4452 Closure Report Cover Sheet Form (.docx)
EQP4452 Closure Report Cover Sheet Form (.pdf)
EQP4460 Certificate Of Deposit Or Time Deposit Account Part 213 (.docx)
EQP4460 Certificate Of Deposit Or Time Deposit Account Part 213 (.pdf)
EQP4461 Escrow Agreement - Part 213 (.docx)
EQP4461 Escrow Agreement - Part 213 (.pdf)
EQP4462 Performance Bond - Part 213 (.docx)
EQP4462 Performance Bond - Part 213 (.pdf)
EQP4463 Trust Agreement - Part 213 (.docx)
EQP4463 Trust Agreement - Part 213 (.pdf)
EQP4464 Financial Test and Financial Test/Corporate Guarantee - Part 213 (.docx)
EQP4464 Financial Test and Financial Test/Corporate Guarantee - Part 213 (.pdf)
EQP4465 Letter of Credit - Part 213 (.docx)
EQP4465 Letter of Credit - Part 213 (.pdf)
EQP4467 Site-Specific Volatilization to Indoor Air Criteria and Site-Specific Target Levels Request (.pdf)
EQP4469 Leaking Underground Storage Tank Site Classification Form (.pdf)
EQP4470 Precluding Factors Assessment PVI Lateral Inclusion Zone (.pdf)
EQP4471 Precluding Factors Assessment PVI Vertical Separation Distance (.pdf)
EQP4476 Notice of Discarded or Abandoned Containers (.docx)
EQP4482 Notice of Migration of Contamination (.docx)
EQP4482 Notice of Migration of Contamination (.pdf)
EQP4483 Request For Mixing Zone Based GSI Criteria (.docx)
EQP4483 Request For Mixing Zone Based GSI Criteria (.pdf)
EQP4506 Public Highway Institutional Control (.docx)
EQP4506 Public Highway Institutional Control (.pdf)
EQP4507 Certificate of Deposit - Part 201 (.docx)
EQP4507 Certificate of Deposit - Part 201 (.pdf)
EQP4508 Declaration of Restrictive Covenant Part 201 (.docx)
EQP4508 Declaration of Restrictive Covenant Part 201 (.pdf)
EQP4509 Escrow Agreement -Part 201 (.docx)
EQP4509 Escrow Agreement -Part 201 (.pdf)
EQP4510 Financial Test Corporate Guarantee (.docx)
EQP4510 Financial Test Corporate Guarantee
EQP4511 Letter of Credit (.docx)
EQP4511 Letter of Credit (.pdf)
EQP4514 Postclosure Agreement (.docx)
EQP4514 Postclosure Agreement (.pdf)
Financial Assurance Calculators
Financial Assurance Mechanism: Present Net Worth (.pdf)
Financial Assurance Mechanism: Present Worth Calculator (.xls)