Forms, Applications, Permits, Manuals and Other Documents

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The department has changed all fill-in forms to PDF fill-in. (Most of the forms have fill-in fields, but some forms are still in the process of conversion.)  You will be able to save and reuse these PDF forms. However, you will need Adobe Acrobat Reader 7 or higher to save the PDF fill-in form. Also, at this time the department does not accept digital signatures. If your Acrobat Reader prompts you to use one, we ask that you don't.

Fill in forms will accept only a limited amount of information in each individual box. If you need to insert more information than the form will accept, please use a supplemental sheet.

Permit Assistant

If you're seeking an environmental permit, registration or certification for your business, school, community, or activity, the Missouri Department of Natural Resources' Permit Assistant can help! This tool is designed to help users determine what type of environmental permits they need and provide the forms to apply for these permits. This easy-to-use tool will ask you a few simple questions to determine your needs.

Start Permit Assistant!

Community Assistance

The department's Community Assistance helps local govrnments easily access assistance and resources to make informed, common-sense decisions about environmental protection for their community.

Learn about Community Assistance

General Information

• Environmental Permits and How to Obtain Them, Booklet--PUB98
• Guide to Missouri Department of Natural Resources Permit Transfers, Booklet--PUB541
• Understanding Environmental Regulations and Permits, Booklet--PUB595
• Manuals
  • Water Pollution Control Permit Manual

Air Pollution

Sales Tax Exemption forms are no longer processed by the Department of Natural Resources. Applicants should use the Missouri Department of Revenue's Form 149 Sales/Use Tax Exemption Certificate and issue them directly to seller. They do not need to be sent to the Department of Revenue.

• 2016 Early School Bus Replacement Application, Form--780-2573
• Performance Test Plan Template, Form--MO 780-2184 Note: Use pages specific to process type unless unavailable then use generalized template pages.
• List of Air Emissions Testing Firms
• Dry Cleaner Notification of Compliance Status, Form--MO 780-1987
• Intermediate Operating Permit Compliance, Certification and Monitoring Report Form--MO 780-1810 and Instructions
• PART 70 Operating Permit Compliance, Certification and Monitoring Report Form--MO 780-1808 and Instructions
• Notice of Violation/Excess Emissions 780-1640

Ambient Air Quality Monitoring

• Quality Assurance Project Plan (QAPP) Template

Asbestos (General)

• Application for Asbestos Occupation Certification, Form--MO 780-2667 As of Jan. 1, 2017, a fee increase applies to certification for all asbestos occupations. Form 780-2667 contains all of the details. Incorrect fees will delay the processing of your application.
• Asbestos Business Exemption Application, Form--780-1222
• Asbestos Contractor Registration Application, Form--MO 780-1224 As of Jan. 1, 2017, the fee for contractor registrations is $2,650.
• Asbestos NESHAP Notification of Demolition and Renovation, Form--MO 780-1923 As of Jan. 1, 2017, the review fee is $100 for asbestos NESHAP notifications of demolitions and renovations.
• Asbestos NESHAP Notification of Demolition and Renovation Amendment, Form--MO 780-1986
• Asbestos Notification Amendment, Form--MO 780-1556
• Asbestos Post-Notification, Form--MO 780-1225
• Asbestos Project Notification, Form--MO 780-1226 As of Jan. 1, 2017, the review fee is $200 for notification of asbestos abatement projects.
• Training Course Accreditation, Form--MO 780-1229 The department noticed an editorial error on Form 1229 and corrected it.
• Asbestos Inspection Report - Demolition/Renovation, Form--MO 780-2130

Asbestos Abatement Contractor Registration

• Asbestos Contractor Registration Application, Form--MO 780-1224 As of Jan. 1, 2017, the fee for contractor registrations is $2,650.

Asbestos Removal Notification

• Asbestos Project Notification, Form--MO 780-1226 As of Jan. 1, 2017, the review fee is $200 for notification of asbestos abatement projects.

Concrete Batch Operation

• These files are currently under development. For questions, contact the construction permit unit at 573-751-4817.

Construction Permits (New Source Review Permits)

Please note: This application can be used for De Minimis, Minor Source, Major Source New Source Review/Prevention of Significant Deterioration (PSD) or Major New Source Review Hazardous Air Pollutant (HAP) Permits.  (Air Construction Permits Guidance information.)

• Application for Authority to Construct, Packet--MO 780-1323 and Instructions
  • Form 2.0 (Form 2.0 is an addendum to MO 780-1323. Duplicate this page for each emission point as needed. )
  • Information regarding fee adjustments taking effect Jan. 1, 2017
• Portable Source Relocation Request--MO 780-2803
• Pre-construction Prohibition Waiver, Fact Sheet--PUB2014

Emissions Banking and Trading

• Emissions Banking and Trading, Form--MO 780-1875 and Instructions

Emission Inventory Questionnaire (EIQ)

• EIQ Forms Excel Workbook - Excel Format
• Full Emission Inventory Questionnaires
• Reduced Emission Reporting
• Overview of EIQ Forms
• Glossary of EIQ Terms
• Confidential EIQ Information Guidance
• Section 112 Hazardous Air Pollutants
• Exempt VOC List
• Dry Cleaner - Non-Chlorinated and Petroleum Based Solvents, Form--MO 780-1954 and Instructions
• EIQ Form 1.0 General Plant Information, Form--MO 780-1431 and Instructions
• EIQ Form 1.1 Process Flow Diagram, Form--MO 780-1619 and Instructions
• EIQ Form 1.2 Summary of Emission Units and Related Processes, Form--MO 780-1620 and Instructions
• EIQ Form 2.0 Emission Unit Information, Form--MO 780-1621 and Instructions
• EIQ Form 2.0 Part 70 Operating Permit Emission Unit Information, Form--MO 780-2087 and Instructions
• EIQ Form 2.0C Part 70 Operating Permit Control Device Information, Form--MO 780-2088 and Instructions
• EIQ Form 2.0C Control Device Information, Form--MO 780-1434 and Instructions
• EIQ Form 2.0K Charcoal Kiln Information, Form--MO 780-1530 and Instructions
• EIQ Form 2.0L Landfill Worksheet, Form--MO 780-1583 and Instructions and Landfill Excel Spreadsheet
• EIQ Form 2.0P Portable Plant Information, Form--MO 780-1433 and Instructions
• EIQ Form 2.0S Stack/Vent Information, Form--MO 780-1435 and Instructions
• EIQ Form 2.0Z Ozone Season Information - "Emissions Statement," Form--MO 780-1452 and Instructions
• EIQ Form 2.1 Fuel Combustion Worksheet, Form--MO 780-1436, Instructions and Fuel Parameters Table
• EIQ Form 2.2 Incinerator Worksheet, Form--MO 780-1438, Instructions and Classification of Waste Table
• EIQ Form 2.3 VOC Process Mass-Balance Worksheet, Form--MO 780-1440 and Instructions
• EIQ Form 2.4 Volatile Organic Liquid Loading Worksheet, Form--MO 780-1625 and Instructions
• EIQ Form 2.5L General Liquid Storage Tank Information, Form--MO 780-1444 and Instructions
• EIQ Form 2.7 Haul Road Fugitive Emissions Worksheet, Form--MO 780-1445, Instructions and AP-42 13.2.2-1 Chart
• EIQ Form 2.8 Storage Pile Worksheet, Form--MO 780-1446, Instructions and AP-42 13.2.4-1 Chart
• EIQ Form 2.9 Stack Test/Continuous Emissions Monitoring Worksheet, Form--MO 780-1447 and Instructions
• EIQ Form 2.T Hazardous Air Pollutant Worksheet, Form--MO 780-1448 and Instructions and HAP List
• EIQ Form 3.0 Emissions Fee Calculation, Form--MO 780-1509 and Instructions
• EIQ Form 3.0CK Charcoal Kiln Emissions Fee Calculation, Form--MO 780-1508 and Instructions
• EIQ Form 3.0 Part 70 Operating Permit Emissions Fee Calculation, Form--MO 780-2089 and Instructions
• EIQ Form 4.0 Financial Cost Estimate, Form--MO 780-1622 and Instructions

Enforcement

• Air Emission Standards for Tanks Surface Impoundments and Containers Inspection Checklist, Form--780-2181
• Air Emission Standards for Equipment Leaks Inspection Checklist, Form--780-2182
• Air Emission Standards for Process Vents Inspection Checklist, Form--780-2183
• Guide to 40 CRF, Part 6, Subpart 000 (also known as NSPS-000): Standards of Performance for Nonmetallic Mineral Processing Plants

Gateway Vehicle Inspection Program

• Financial Waiver Eligibility Request, Form--MO 780-1970
• Cost-Based Waiver Application Affidavit - Repairs Made by a Repair Technichian, Form--MO 780-1971
• GVIP Promotional Items Order Form, Form--MO 780-2031
• Mileage-Based Exemption Request, Form--MO 780-1972
• Cost-Based Waiver Application Affidavit - Repairs Made by a Vehicle Owner, Form--MO 780-1973
• Estimate-Based Waiver Application Affidavit - Estimate Provided by a Vehicle Repair Technician, Form--MO 780-1994
• Compliance Inspection Form, Form--MO 780-2140
• Out of Area Waiver Request, Form--MO 780-2202
• Reciprocity Request - Emissions Inspection, Form 780-2192

Open Burning Permit

• Application for Permit to Open Burn Vegetative Waste, Form--MO 780-1941
• Application for Permit to Open Burn Vegetation With an Air Curtain Destructor (ACD) in the St. Louis Region*, Form--MO 780-1840
• Facts on Open Burning Under Missouri Regulations, Fact Sheet--PUB2047

Operating Permit Application Forms (Basic)

• Basic Operating Permit Notification, Form--MO 780-1872 and Instructions
  • Guideline for Fees for Operating Air Permits

Operating Permit Application Forms (Part 70 and Intermediate/Synthetic Minor)

• Operating Permit, Form--MO 780-1519 and Instructions
  • Guideline for Fees for Operating Air Permits

Operating Permit Compliance, Certification and Monitoring Report Form

• Intermediate Operating Permit Compliance, Certification and Monitoring Report, Form--MO 780-1810 and Instructions
• PART 70 Operating Permit Compliance, Certification and Monitoring Report, Form--MO 780-1808 and Instructions

Permit-By-Rule Notifications

• Application for Authority to Construct, Permit by Rule Notification - Crematories and Animal Incinerators, Form--MO 780-1888
• Application for Authority to Construct, Permit by Rule Notification - Livestock Markets and Livestock Operations, Form--MO 780-1886
• Application for Authority to Construct, Permit by Rule Notification - Printing Operations, Form--MO 780-1889
• Application for Authority to Construct, Permit by Rule Notification - Surface Coating Operations, Form--MO 780-1887

Portable Source Relocation Request

• Portable Source Relocation Form--MO 780-2803
  * In addition to completing and submitting this form, also fill out and submit Form 2.7 and Form 2.8, two subforms found in Form 1323: “Application for Authority to Construct.”

Quarry

• These files are currently under development. For questions, contact the construction permit unit at 573-751-4817.

Vapor Recovery (General)

• Request for Exemption Stage 1 Requirement Regulation, Form--MO 780-1528
  10 CSR 10-5.220, (4) - St. Louis;
• 10 CSR 10-2.260, (3) - Kansas City Bulk Plants / "Gasoline Loading"
• St. Louis County-Department of Health Vapor Recovery System Construction/Operating Permit Application
• Vapor Recovery System Construction/Operating Permit Application--MO 780-2522

Financial Assistance Center

• Applicant Assurance Local Funding
• State Revolving Fund Certificate of Title to Site

Clean Water

• Clean Water Forty Percent Grant Application, Form--MO 780-2001 and Instructions
• Clean Water Small Community Engineering Assistance Application, Form--MO 780-2217
• Clean Water State Revolving Fund Application, Form--MO 780-1951 and Instructions
• Clean Water State Revolving Fund Green Project Reserve, Form--MO 780-2530
• Clean Water State Revolving Fund Governing Body Resolution for Authorized Representative
• Clean Water State Revolving Fund Applicant Assurance of Easements
• Clean Water Statement of Work Completed
• Facilities Plan Submittal Checklist, Form--MO 780-2041
• Land Acquisition and Relocation Fact Sheet
• Rural Sewer Grant Application, Form--MO 780-2036 and Instructions
• Small Borrower Loan Application, Form--MO 780-2035
• State Revolving Fund Cost and Effectiveness Certification Form, Form--MO 780-2660
• Fiscal Sustainability Certification Form, Form--MO 780-2661

Drinking Water

• Drinking Water State Revolving Fund Pre-closing Document Submittal Checklist
• Drinking Water State Revolving Fund Governing Body Resolution for Authorized Representative
• Drinking Water State Revolving Fund Applicant Assurance of Easements
• Drinking Water State Revolving Fund Loan Application, Form--MO 780-1845
• Drinking Water State Revolving Fund Facility Plan Submittal Checklist, Form--MO 780-2091
• Land Acquisition and Relocation
• Small Borrower Loan Application, Form--MO 780-2035
• Technical, Managerial and Financial Capacity Assessment Checklist for Public Water Systems

Geological Survey

• McCracken Core Library and Research Center Sample Request Form, Form--MO 780-2220

Education

• Publication Order, Form--MO 780-1730

Land Reclamation

Coal Exploration Permit

• Forms available by contacting the Land Reclamation Program at 573-751-4041.

Industrial Mineral Surface Mining Permits

In-Stream Sand and Gravel Operations

• In-Stream Sand and Gravel Operations Permit Application Guidance, Fact Sheet – PUB2460
• Permit Application and Renewal for Industrial Mineral Mines, Form--MO 780-1007
• Sand and Gravel Excavation Plan--MO 780-1895
• Company Information, Form--MO 780-1928
• Permit Transfer, Form--MO 780-1333
• Annual Operations Status Report, Form--MO 780-1884
• Public Notice to Local Newspaper and Certified Mail to Adjacent Landowners and Government Bodies Templates
• New Permit
• Renewal
• Revision
• Transfer
• Expansion
• Transfer-Expansion to Permit
• Transfer-Expansion to Site
• New to Existing Permit

Open Pit Operations

• Open Pit Operations Permit Application Guidance, Fact Sheet—PUB2464
• Permit Application and Renewal for Industrial Mineral Mines, Form--MO 780-1007
• Mine Plan and Form Instructions, Form--MO 780-1327
• Company Information, Form--MO 780-1928
• Permit Transfer, Form--MO 780-1333
• Annual Operations Status Report, Form--MO 780-1885
• Request for Approval of Reclaimed Land, Form--MO 780-0946
  • Notice of Request for Approval of Reclaimed Land
• Public Notice to Local Newspaper and Certified Mail to Adjacent Landowners and Government Bodies Templates
  • New Permit
  • Renewal
  • Revision
  • Transfer
  • Expansion
  • Transfer-Expansion
  • New to Existing Permit
• Financial Bonding Forms:
• Surety Bond Surface Mining of Minerals, Form--MO 780-0016
• Personal Bond Secured by A Certificate of Deposit, Form--MO 780-0936
• Personal bond Secured by a Letter of Credit, Form--MO 780-1472
• Confirmation of Irrevocable Letter of Credit, Form--MO 780-0015

Metallic Mineral Waste Management Permit

Permit consists of an Inspection-Maintenance and Closure Plan that is available by contacting the Land Reclamation Program at 573-751-4041.

Surface Coal Mine and Reclamation Permit

Forms available by contacting the Land Reclamation Program at 573-751-4041.

Oil and Gas

• Oil and Gas Commercial Operator's License Application, Form--MO 780-0209
• Oil & Gas Well Extended Shut-In Status Application, Form--MO 780-0210
• Oil & Gas Well Bond, Form--MO 780-1777
• Oil and Gas Well Financial Assurance Instrument Certification, Form--MO 780-1778
• Oil and Gas Permit to Drill or Modify Well Application, Form--MO 780-0211
• Oil and Gas Permit to Inject or Injection Permit Modification Application, Form--MO 780-0212
• Oil and Gas Annual Well Inventory Report, Form--MO 780-0213
• Oil and Gas Confirmation of Out Of State Irrevocable Letter of Credit, Form--MO 780-1136
• Oil and Gas Well Completion or Recompletion Report and Well Log, Form--MO 780-0215
• Oil and Gas Notice of Intention to Abandon Well, Form--MO 780-0214
• Oil and Gas Well Plugging Report, Form--MO 780-0217
• Oil and Gas Well Conversion to a Water Well Application, Form--MO 780-0218
• Oil and Gas Monthly Well Status Production and Disposal Report, Form--MO 780-0219
• Oil and Gas First Purchaser Fee Report, Form--MO 780-0221
• Oil and Gas Annual Injection Well Monitoring Report, Form--MO 780-0208
• Oil and Gas Notice to Cancel Well Permit--MO 780-2227
• Class V Well Inventory Form, Form--MO 780-1774
• Oil and Gas Non-Commericial Operator's License Application, Form--MO 780-2598
• Oil and Gas Annual Bonding Report, Form--MO 780-2699
• Oil and Gas Transfer of Well(s) and/or Transfer of Injection Permit(s), Form--MO 780-2634
• Oil and Gas Mechanical Integrity Test Report, Form--MO 780-2635

Water

Dam Safety

• Dam Inventory Questionnaire, Form--MO 780-1755
• Application for Construction Permit, Form--MO 780-1763
• Certification - Construction Permit Application, Form--MO 780-1764
• Certification - Registration Permit Application, Form--MO 780-1756
• Application for Registration Permit, Form--MO 780-1758
• Application to Renew Registration Permit, Form--MO 780-1757
• Application for Safety Permit, Form--MO 780-1759
• Certification - Safety Permit Application, Form--MO 780-1760
• Application to Renew Safety Permit, Form--MO 780-1761
• Agricultural Exemption Information Sheet, Form--MO 780-1765
• Inquiry and Information, Form--MO 780-1762

Construction Permit Checklists

• Construction Permit Application - Earth Dam
• Construction Permit Application - Modification to Existing Earth Dam
• Construction Permit Application - Industrial Water Retention Dam

Registration and Safety Permits Checklists

• Registration Permit Application - Earth Dam
• Registration Permit Application - Industrial Water Retention Dam
• Safety Permit Application - Earth Dam
• Safety Permit Application - Industrial Water Retention Dam

Geohydrologic Evaluation

• Request for Geohydrologic Evaluation of Liquid-Waste Treatment Facility/Site, Form--MO 780-1688
• Request for Geohydrologic Evaluation of Residential Housing Development (Subdivision), Form--MO 780-1690

Major Water Users

• Online Annual Registration
• Major Water Use Registration Form, Form--MO 780-2019
• Major Water Use Registration Form For Mines and Quarries, Form--MO 780-2020

Solid Waste Disposal Areas

• Request for Preliminary Investigation of Area Proposed for Beneficial Reuse of Solid Waste, Form--MO 780-1691
• Request for Preliminary Investigation of Proposed Solid-Waste Disposal Area, Form--MO 780-1689

Underground Injection Control

• Class V Well Inventory Form, Form--MO 780-1774

Water, Heat Pump and Monitoring Wells

Well Certification and Registration

• Charitable or Benevolent Organization Well Record and Pump Information, Form--MO 780-2185
• Closed Loop Heat Pump Certification Record, Form--MO 780-1413
• Domestic/Multifamily Well Record and Pump Information Data, Form--MO 780-1902
• Monitoring Well Certification Record, Form--MO 780-1415
• Pilot Hole for a Public Water Supply Well Certification Record, Form--MO 780-2201
• Public Well/High Yield Record, Form--MO 780-1901
• Pump Information Record, Form--MO 780-1900
• Reconstruction Record, Form--MO 780-1414
• Monitoring Well Plugging Registration Record--MO 780-2161
• Nested Monitoring Well Certification Record, Form--MO 780-2169
• Well Plugging Registration Record, Form--MO 780-1603

Driller and Pump Installation Contractor Permitting

• Contractor and Apprentice Testing Application, Form--MO 780-1424
• Contractor Permit Application, Form--MO 780-1731
• Prenotification Form, Form--MO 780-2167
• Prenotification Form, Online Submission
• Personal Bond - Secured by an Irrevocable Letter of Credit, Form--MO 780-2044
• Personal Bond - Secured by Certificate of Deposit, Form--MO 780-2045
• Personal Bond - Secured by Surety Bond, Form--MO 780-2054
• Vehicle Application, Form--MO 780-1425

Misc. Other Forms

• Casing Depth Request, Form--MO 780-1426
• Investigation Request, Form--MO 780-1618
• Public Water Supply Notification, Form--MO 780-1427
• Variance Request, Form--MO 780-1422
• Lost or Destroyed Well Reporting Form for Tanks Sites--MO 780-2158 

Water Trace

• Water Trace Information Sheet Injection Point, Form--MO 780-1693
• Water Trace Information Sheet Monitoring Point, Form--MO 780-1694
• Water Trace Information Sheet Water Tracer Registration Application, Form--MO 780-1695

Hazardous Waste

Drycleaning Environmental Response Trust (DERT)

• DERT Fund - Consent for Access to Property, Form--MO 780-1945
• Drycleaning Environmental Response Trust Fund Quarterly Report, Form--MO 780-2100
• Dry Cleaning Facility Change of Ownership, Form--MO 780-1877
• Dry Cleaner Registration - Perchloroethylene and Other Chlorinated Solvents, Form--MO 780-1745 and Instructions
• Dry Cleaning Solvent Surcharge Calculation Sheet (Part 1 and Part 2), Form--MO 780-1725
• Missouri Drycleaning Environmental Response Trust (DERT) Fund Application, Form--MO 780-1837
• Notice of Closure of a Dry Cleaning Facility, Form--MO 780-1876
• Prioritization Ranking, Form--MO 780-1894
• Reimbursement Claim Worksheet, Form--MO 780-1891

Brownfields/Voluntary Cleanup

• Brownfields Assessment Application, Form--MO 780-1955
• Brownfields/Voluntary Cleanup Program (BVCP) Application, Form--MO 780-1712
• Brownfields/Voluntary Cleanup Program Quarterly Report, Form--MO 780-2101
• Consent for Access to Property, Form--MO 780-1713

Electronics Recycling

• Basic Closure Plan, Form--MO 780-2218
• Electronics Manufacturer Registration, Form--780-2106
• Electronic Scrap Recycler Inspection Checklist, Form--MO 780-2097
• Host Site Registration, Form--MO 780-1981
• Host Site Self-Audit, Form--MO 780-1980
• Registered Electronics Manufacturer Recycling Report--MO 780-2128 - 2010
• Registered Electronics Manufacturer Recycling Report--MO 780-2157

Federal Facilities

• Former Minuteman Missile Site Property Change Request, Form--MO 780-2040

Hazardous Waste Treatment, Storage and Disposal Facilities and Resource Recovery Facilities

• Certified Resource Recovery Facility Application, Form--MO 780-1163Instructions
• EPA RCRA Hazardous Waste Part A Permit Application -- EPA 8700-23
• Missouri Hazardous Waste Management Facility Application Form

Hazardous Waste Generators

• Generator's Hazardous Waste Summary Report, Part I and II, Form--MO 780-1097 - A guide to help you locate specific information to complete this report.
• Facility Summary Report, Part I and II, Form--MO 780-0408
• Hazardous Waste Generator's Exception Report, Form--MO 780-0651
• Notification of Regulated Waste Activity, Form--MO 780-1164 (For acquiring an EPA ID Number.) A registration fee is required for all new registrations or to re-activate a currently inactive registration.
• Waste Stream Analysis, Form—MO 780-2219
• Registration for Hazardous Waste Generator E-Reporting, Form--MO 780-2531

Hazardous Waste Generator Inspection Checklists

• Waste Stream Analysis, Form—MO 2219
• Electronic Scrap Recycler Inspection Checklist, Form--MO 780-2097
• Small Quantity Generator Inspection Checklist, Form--MO 780-1602
  • Small Quantity Generator Inspection Checklist - Previous Version
  • Small Quantity Generator – Tank Attachment, Form--MO 780-2527
  • Used Oil Attachment, Form--MO 780-2526
  • Universal Waste Attachment – Small Quantity Handler, Form--MO 780-2523
  • Universal Waste Attachment – Small Quantity Handler - Previous Version
• Large Quantity Generator Inspection Checklist, Form--MO 780-1525
  • Large Quantity Generator – Tank Attachment, Form--MO 780-2524
  • Used Oil Attachment, Form--MO 780-2526
  • Large Quantity Generator Inspection Checklist - Previous Version
• Solvent Contaminated Wipes, Form--MO 780-2641

Hazardous Waste Transporters

• Note: Hazardous Waste Transporter Licenses are now issued by MoDOT, Motor Carrier Services Unit http://www.modot.org/mcs/index.htm
• Hazardous Waste Transporter and Facility Checklist, Form--MO 780-2107

Polychlorinated Biphenyl (PCB) Facility

• Polychlorinated Biphenyl (PCB) Facility Application, Form--MO 780-1897

Radioactive Materials Shipment

• Missouri Radioactive Materials Shipment Notification and Fee Payment, Form--MO 780-2146
• Missouri Low-Level Radioactive Waste Shipment Form, Form--780-2663

Underground Storage Tank (UST) (includes underground petroleum storage tank)

• Information regarding underground storage tank systems
• Notification - Installation of New Underground Storage Tank System, Form--MO 780-1949
• Underground Petroleum Storage Tank Registration, Form and Instructions--MO 780-1782
• Closure Report for Petroleum Releases at Underground Storage Tank Sites--MO 780-2120
• Closure Report for Petroleum Releases at Underground Storage Tanks - Soil Analysis--MO 780-2141
• Closure Report for Petroleum Releases at Underground Storage Tanks - Groundwater Analysis--MO 780-2142
• Closure Notice for Petroleum Releases at Underground Storage Tank Sites--MO 780-2121
• Regulatory Requirements for Installations for New Underground Storage Tank Systems Compliance Checklist--MO 780-2134
• Tank Piping Information Instructions

Used Oil

• Transporter's Used Oil Annual Report, Form--MO 780-1555 and Instructions
• Transporter's Used Oil Shipment Record, Form--MO 780-1449
• Used Oil Aggregation Point Facility, Inspection and Record Checklist, Form--MO 780-1523
• Used Oil Burners Who Burn Off-Specification Used Oil for Energy Recovery, Inspection and Record Checklist, Form--MO 780-1520
• Used Oil Collection Center, Inspection and Record Checklist, Form--MO 780-1524
• Used Oil Fuel Marketers, Inspection and Record Checklist, Form--MO 780-1526
• Used Oil Generator, Inspection Record and Checklist, Form--MO 780-1890
• Used Oil Processors and Re-Refiners, Inspection and Record Checklist, Form--MO 780-1521
• Used Oil Transporter and Transfer Facilities, Inspection and Record Checklist, Form--MO 780-1522

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Historic Preservation (includes Section 106)

• Archaeological Site Recordation, Form--MO 780-1927
• Section 106 Project Information Form--MO 780-1027
  • Missouri Drainage Basin Map (To be used when filling out at Section 106 form.
• Section 106 Survey Memo Form--MO 780-1718 and Instructions
• Preliminary National Register of Historic Places Eligibility Assessment--MO 780-1878 and Instructions
• Barn and Farmstead Survey Form--MO 780-2126 and Instructions
• Barn and Farmstead Survey Continuation Sheet--MO 780-2127 and Instructions
• Architectural/Historic Inventory Form--MO 780-2125 and Instructions

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Human Resources

• Application for Temporary Employment, Form--MO 780-1601
• Summer Professional Development Program Application, Form--MO 780-2009
• Summer Professional Development Program Recommendation Letter, Form--MO 780-2010

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Inspections

• What to Expect During an Environmental Inspection

Air

• Level II State Source Inspection Form--MO 780-2178

Water

• Control Authority Pretreatment Audit Checklist – MO 780-2590
• Control Authority Pretreatment Inspection Checklist – MO 780-2591
• Inspection Checklist - Stormwater-Land Disturbance/Water Pollution Control Facilities -- MO 780-2593
• Inspection Checklist - Concentrated Animal Feeding Operations and Animal Feeding Operations – MO 780-2594
  
  

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Operator Certification and Training

• Application: For Examination for a Water Treatment, Water Distribution, Wastewater Operator or Concentrated Animal Feeding Operations (CAFO) Certificate--MO 780-1089
• Application: For Reciprocity of a Water Treatment, Water Distribution, Wastewater or Concentrated Animal Feeding Operations (CAFO) Operator Certificate--MO 780-1091
• Contract Operator Form, Form--MO 780-2002

Water Protection Program Operator Certification

• Request for Training and Course Approval, Form--MO 780-1892

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Public Drinking Water

• Application for Source Water Protection Development and Implementation Grant, Form--MO 780-2163 and Instructions
• Application for State Revolving Fund Contract for Engineering Services, Form--MO 780-2177
• Compliance & Operational Inspection--MO 780-1617
• Consumer Confidence Report Distribution Certification--MO 780-2212
• Design Standards Exception Request--MO 780-2221
• Disinfection and Turbidity Report for Surface Water Systems > 10,000 Population, Form--MO 780-1591
• Disinfection and Turbidity Report for Surface Water Systems < 10,000 Population, Form--MO 780-1904
• Drinking Water State Revolving Fund Loan Application, Form--MO 780-1845 and Instructions
• Inventory Public Water System Record--MO 780-1231 and Instructions
• Inventory Address Data--MO 780-1232 and Instructions
• Inventory Source and Treatment Record--MO 780-1233 and Instructions
• Microbiological Analysis Report, Form--MO 780-0438
• Monthly Compliance Monitoring Report for Groundwater Systems, Form--MO 780-2094
• Monthly UV Operation Report, Form--MO 780-2208
• Notification of Fluoride Modification, Form--MO 780-2685
• Order Bacteriological Water Analysis Sample Bottles
• Permit to Dispense Application, Form--MO 780-2122
• Permit to Dispense Application for Transient Noncommunity Water Systems, Form--780-2228
• Permit to Dispense Transfer Application--MO 780-2139
• Report of Low Water Pressure--MO 780-2016
• Revised Total Coliform Rule - Level 1 Assessment Form--MO 780-2638
• Seasonal Public Water System Start-up Procedures Certificaiton Form--MO 780-2607
• Stage 2 Disinfectants and Disinfection Byproduct Rule Operational Evaluation Level (OEL) Report-- MO 780-2687
• Well Plugging Grant Application, Form--MO 780-2162 and Instructions

Certification

• Application: For Examination for a Water Treatment, Water Distribution, Wastewater Operator or Concentrated Animal Feeding Operations (CAFO) Certificate--MO 780-1089

Construction

• Construction Permit Application, Form--MO 780-0701
• Backflow Prevention Assembly Test Data and Maintenance Report, Form--MO 780-0804

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Soil and Water Conservation

• Landowner Authorization for Cost-Share, Form--MO780-2224

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Solid Waste

• Certificate of Acknowledgement, Form--MO 780-1271
• Certificate of Insurance for Closure Application, Form--MO 780-1268
• Contract of Obligation, Form--MO 780-1263
• Closure and Post-Closure Cost Worksheet, Form--MO 780-1882
• Corporate Guarantee, Form--MO 780-1270
• Financial Guarantee Bond, Form--MO 780-1265
• Fiscal Year District Operations Grant Profile and Budget, Form--MO 780-1992
• Form A - Active Gas System Worksheet, Form--MO 780-1881
• Form B - Passive Gas System Worksheet, Form--MO 780-1880
• General Information on Solid Waste permits
• Irrevocable Escrow Agreement, Form--MO 780-1264
• Irrevocable Standby Letter of Credit, Form--MO 780-1267
• Irrevocable Trust Agreement, Form--MO 780-1272
• Letter from Chief Financial Officer, Form--MO 780-1269
• Performance Bond, Form--MO 780-1266
• Resolution - Attachment A, Form--MO 780-2039
• Schedule A Form, Form--MO 780-2043
• Sheltered Workshop Recycling Form--MO 780-2150 and Instructions
• Solid Waste Technician Certification Class Enrollment Form--MO 780-2000

Tonnage Fee Reporting

• Demolition Landfill Solid Waste Tonnage Fee Report, Form--MO 780-1368
• Infectious Waste Processing Facility Fee Report, Form--MO 780-1905
• Sanitary Landfill Solid Waste Tonnage Fee Report, Form--MO 780-1367
• Transfer Station Solid Waste Tonnage Fee Report, Form--MO 780-1369

Infectious Waste Processing Facility Construction and Operating Permits

Forms may be obtained by calling the Solid Waste Management Program at 573-751-5401.

Inspection Checklists

• Closed Sanitary/Demolition/Utility Waste/Special Waste Landfill Inspection Checklist, Form--780-0105
• Processing Facility Inspection Checklist, Form--780-0343
• Active Sanitary Landfill Inspection Checklist, Form--MO 780-0354
• Scrap Tire Processor Inspection Checklist, Form--MO 780-1962
• Scrap Tire Collection Center Inspection Checklist, Form--MO 780-1715
• Active Demolition Landfill Inspection Checklist, Form--MO 780-2561

Solid Waste Disposal Area

• Application for Solid Waste Disposal Area or Processing Facility Construction Permit, Form--MO 780-0393
• Non-Profit Scrap Tire Cleanup and Disposal Application, Form--MO 780-1997
• Non-Profit Scrap Tire Cleanup and Disposal Invoice, Form--MO 780-1998
• Officer/Management Employee Summary Sheet, Form--MO 780-1042
• Table 1 - Cover Systems Construction and Repair Costs, Form--MO 780-1879
• Violation History Disclosure Statement and Summary Sheet, Form--MO 780-1250

Solid Waste Disposal Area Construction Permit

• Application for Solid Waste Disposal Area or Processing Facility Construction Permit, Form--MO 780-0393

Solid Waste Disposal Area Operating Permit

Forms may be obtained by calling the Solid Waste Management Program at 573-751-5401.

Solid Waste Management Districts

• District Grant Application and Funding Request Form, Form--MO 780-2165 and Instructions
• District Grant Subgrantee Profile and Plan Implementation Form, Form--M0 780-1991 and Instructions
• Fiscal Year District Operation Grant Profile and Budget Form, Form--MO 780-1992 and Instructions
• Solid Waste Management District Annual Report, Form--MO 780-1989 and Instructions
• Solid Waste Management District Status Report, Form--MO 780-1993 and Instructions

Solid Waste Processing Facility Construction Permit

• Application for Solid Waste Disposal Area or Processing Facility Construction Permit

Solid Waste Processing Facility Operating Permit

Forms may be obtained by calling the Solid Waste Management Program at 573-751-5401.

Special Wastes

• Special Waste Disposal Request Form--MO 780-1166

Scrap Tire End-User Registration

• Application for Scrap Tire Beneficial Use Approval, Form--MO 780-2042
• Scrap Tire End-User Registration Form--MO 780-1594
• Scrap Tire Processing Facility Operations Records Form--MO 780-1037
• Scrap Tire Processing Facility Permit Application, Form--MO 780-1597
• Scrap Tire Monthly Summary Tracking Form - Collection Center--MO 780-1596
• Scrap Tire Tracking Form--MO 780-1593
• Scrap Tire Monthly Summary Tracking Form - Hauler--MO 780-1595
• Playground Scrap Tire Surface Material Grant Application, Form--780-2143 and Instructions
• Non-Playground Scrap Tire Surface Material Grant Application, Form--780-2144 and Instructions
• Disaster Recovery Scrap Tire Surface Material Grant Application, Form--780-2145 and Instructions

Scrap Tire Hauler Permit

Scrap Tire Hauler Permit Application

Scrap Tire Processing Facility Permit

• Application for Scrap Tire Processing Facility Permit--MO 780-1597

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Water Pollution

• Application for Change of Name or Address for you Missouri State Operating Permit, Form--780-2697
• Application for Transfer of Operating Permit--MO 780-1517
• Facility Closure Request Form, Form--MO 780-2512
• Financial Questionnaire -- MO-780-2511
• Variance Application - 644.061 RSMo 1986, Form MO 780-0181

319 Program

• Nonpoint Source Implementation Grant Application, Form--MO 780-1896
  • Detailed Budget to Accompany Form 780-1896 Excel
  • Water Quality Monitoring Worksheet--MO 780-2124
    • Detailed Budget to Accompany Form 780-1896 Excel
• Agricultural BMP Project Deliverables Worksheet, Form--MO 780-2196
• Application for Nonpoint Source Pollution Minigrant, Form--MO 780-1947 and Instructions
  • Detailed Budget to Accompany Form 780-1896 Excel
• Dam and Obstruction Removal or Modification Project Deliverables Worksheet, Form--MO 780-2194
• Innovative Stormwater Demonstration Project Deliverables Worksheet, Form--780-2198
• Lake Management and Restoration Project Deliverables Worksheet, Form--780-2197
• Lake Monitoring Data, Form--MO 780-2047
• Lakes Monitoring Site Information, Form--MO 780-2046
• Mine Drainage Abatement Project Deliverables Worksheet, Form--MO 780-2195
• Nonpoint Source Implementation Grant Application Supplemental Form A - Water Quality Monitoring Worksheet, Form--MO 780-2193
• Stream and Riparian Restoration and Protection, Form--MO 780-2200
• Watershed Management Planning Grant Application--MO 780-2123
  • Attachment A - Nine (9) Elements of a watershed management plan
  • Detailed Budget to Accompany Form 780-1896 Excel
  • Water Quality Monitoring Worksheet--MO 780-2124
    • Detailed Budget to Accompany Form 780-1896  Excel
• Wetlands Restoration, Protection or Conservation Easement Deliverables Worksheet, Form--780-2199

Antidegradation

• Antidegradation Review Summary Attachment A: Tier 2 - Significant Degradation, Form--MO 780-2021
• Antidegradation Review Summary Attachment B: Tier 2 - Minimal Degradation, Form--MO 780-2022
• Antidegradation Review Summary Attachment C: Temporary Degradation, Form--MO 780-2023
• Antidegradation Review Summary Attachment D: Tier 1 Review, Form--MO 780-2024
• Antidegradation Review Submittal Attachment E: Alternatives Analysis for Domestic Wastewater Facilities w/Design Flow Less than 10,000 gal per day, Form--MO780-2804
• Antidegradation Review Summary Tier Determination and Effluent Limit Summary, Form--MO 780-2025
• No Discharge Evaluation, Form--MO 780-2805
• No Degradation Evaluation Conclusion of Antidegradation Review, Form--MO 780-2026
• Water Quality Review Assistance / Antidegradation Review Request, Form--MO 780-1893

Agrichemical Facilities

• Discharge Monitoring Certification for Agrichemical Facilities Under General Permit MO-R24000, Form--MO 780-1723
• Discharge Monitoring Report for Agrichemical Facilities Under General Permit MO-R240000 (Fertilizer Containment), Form--MO 780-1605
• Discharge Monitoring Report for Agrichemical Facilities Under General Permit MO-R240000 (Pesticide Containment), Form--MO 780-1604
• Form A - Application for Operating Permit, Form--MO 780-1479
• Form E - Application for General Permit, Form--MO 780-0795

Concentrated Animal Feeding Operation (CAFO) Construction and Operating Permits National Pollutant Discharge Elimination System (NPDES)

• Form W - Concentrated Animal Feeding Operation (CAFO) Permit, Form--MO 780-2112
• CAFO Annual Report, Form--MO 780-1953 and Instructions
• CAFO Record Keeping Forms Checklist--MO 780-2153
• Form F - Application for Approval or Permit for Concentrated Animal Feeding Operation--MO 780-0725
• 2013 CAFO General Permit (MO-G01)
• 2009 Nutrient Management Technical Standards
• CAFO MOG01 Information

Construction (Water Pollution)

• Application for Construction Permit - Sewer Extension, Form--MO 780-1632
• Application for Construction Permit - Wastewater Treatment Facility, Form--MO 780-2189
• Application for Transfer of Construction Permit--MO 780-2156
• Continuing Authority and Receiving Wastewater Treatment Facility Acceptance--MO 780-2584
• Facility Plan or Engineering Report Review Request--MO 780-2617
• Soils Report Review Request for Land Application of Treated Wastewater, Form--780-2696
• Statement of Work Completed--MO 780-2155

Discharge (Water Pollution)

• Financial Questionnaire -- MO-780-2511
• Form A - Application for Nondomestic Pemit, Form--MO 780-1479
• Form B - Application for Operating Permit for Domestic Wastewater (< 100,000 gallons per day), Form--MO 780-1512
• Form B2 - Application for Operating Permit for Domestic Wastewater (˃100,000 gallons per day), Form --MO 780-1805
• Form C - Application for Discharge Permit - Manufacturing, Commercial, Mining and Silviculture Operations, Form--MO 780-1514
• Form D - Application for Discharge Permit - Primary Industries, Form--MO 780-1516
• Form P - Notification of Hydrostatic Testing Under Permit By Rule, Form--MO 780-1874
• Annual Inflow and Infiltration Report--MO 780-2690
• Operational Monitoring Report - Lagoon--MO 780-2801
• Operational Monitoring Report - Mechanical Wastewater Facility--MO 780-2800
• Whole Effluent Toxicity (WET) Test Report Form--MO 780-1899

eDMR

• eDMR permit Holder and Certifier Registration, Form--MO 780-2204
• eDMR Waiver Request Form, Form--MO 780-2692

General Permits

• Form E - Application for General Permit, Form--MO 780-0795
  • Abandoned Mine Land Rec > 5 acres (G05)
  • Ag/Wood/Food Compost Sites (G09)
  • CAFO (G01)
  • Car Wash (G75)
  • Clay Pits (G84)
  • Dredging Lakes/River Harbor (G69)
  • Dredging on the Missouri and Mississippi Rivers (G698)
  • Feedstock Compost Sites (G92)
  • Fish Farms/Hatcheries (G13)
  • Fuel Spill Cleanup (G94)
  • Heat Pumps (G251)
  • Hydrostatic Testing of Pipelines and Storage Tanks (G67)
  • Land Application of Domestic Wastewater Biosolids (G821)
  • Land Application of Food Processing Wastewater (G822)
  • Limestone Quarries (G49)
  • Oil/Water Separators (G14)
  • Pesticide Applications (G87)
  • Petroleum Storage < 250,000 gallons (G35)
  • Sand and Gravel Washing (G50)
  • Swimming Pools Discharge (G76)
  • Water Treatment Plant Settling Basins (ex. MO and MISS) (G64)
  • Yard Waste Compost Sites (G97)
  • Zeolite Softeners (G641)
• Form B - Application for Operating Permit for Domestic Wastewater (< 100,000 gallons per day), Form--MO 780-1512
  • Domestic Wastewater Non-POTWs Discharging < 50,000 gallons per day (GD)
  • Land Application of Domestic Wastewater (G823)
Form H - Request for Termination of a General Permit, Form--MO 780-1409

Heat Pump Permit

The request must be sent in a letter to the Missouri Department of Natural Resources Water Protection Program. Questions at 10 CSR 20-6.070(2)(B) must be answered in the letter.

Land Application of Domestic Wastewater

• Form B - Application for Operating Permit for Domestic Wastewater (≤ 100,000 gallons per day), Form--MO 780-1512
• Form B2 - Application for Operating Permit for Domestic Wastewater (˃100,000 gallons per day), Form --MO 780-1805
• Form I - Permit Application for Operation of Wastewater Irrigation Systems, Form--MO 780-1686

Land Application of Industrial Wastewater Biosolids and Residuals

• Form A - Application for Nondomestic Permit, Form--MO 780-1479
• Form I - Permit Application for Operation of Wastewater Irrigation Systems, Form--MO 780-1686
• Form R - Permit Application for Land Application of Industrial Wastewater Biosolids and Residuals--MO 780-1684

Land Disturbance

• ePermitting

Residential Wastewater

• Request for Approval Under 10 CSR 20-6.030 Disposal of Wastewater in Residential Housing Developments, Form--MO 780-1706

Sludge

• Form S - Section 1. Domestic Sludge Reporting, Form--MO 780-1636
• Form S - Section 2. Laboratory Results - Form SA and Form SB--MO 780-1630
• Form S - Section 3. Land Application, Form--MO 780-1629
  
• Form S - Section 4. Sludge Hauling, Form--MO 780-1635
• Form S - Section 5. Sludge Disposal Lagoon, Form--MO 780-1634
• Form S - Section 6. Sludge Incineration, Form--MO 780-1633



Stormwater

• ePermitting
• Form E - Application for General Permit, Form--MO 780-0795
• Form G - Application for Stormwater Permit, Under the General Permit: Land Disturbance, Form--MO 780-1408 (Note: Form E Must Be Included)
• Form K - Application for Individual Small MS4 General Permit, Form--MO 780-1802
• Form L - Application for Co-permittee Small MS4 General Permit, Form--MO 780-1801 (Note: Form M must also be submitted)
• Form M - Application For Stormwater Permit Under The General Permit: Small Municipal Separate Storm Sewer System (MS4), Form--MO 780-1800 (Note: Form K or L must be included)
• Stormwater Annual Report - Small MS4 Permits, Form--MO 780-1846
• Stormwater Annual Report - Small MS4 Permits Addendum - Water Quality Program Assessment (Municipal Separate Storm Sewer System), Form--MO 780-2049
• Stormwater General Permits
• Stormwater Permit Requirements for Oil/Water Separators, Technical Bulletin--PUB234

Termination

• Form H - Request for Termination of a General Permit, Form--MO 780-1409
• Form J - Request for Termination of a Site Specific Permit, Form--MO 780-1576

Wetland or Dredge and Fill Approval

Must contact the Department of Natural Resources Water Protection Program and ask for a 401 certification