UST Cleanup Fund Forms and Guides

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Please read the information below before completing our on-line forms:

At this time there is no provision to submit on-line forms electronically.  Only hard copy submittals will be accepted with ”original signatures.”

IMPORTANT: You will not be able to save completed forms, unless you have the full version of
Adobe Acrobat. 

General Use

• Address Change Form
• Claimant Data Record (Std. 204)
• Certification of Non-Recovery
• Power of Attorney

Claim Eligibility

• USTCF Claim Application
• Permit Waiver Persuant to Kelsoe Opinion
• Permit Waiver (for claims filed after 1/1/08)
• Certificate of Compliance with Health & Safety Code Section 25299.549h)
• Commingled Plume Account Application Package

Financial Responsibility

• Financial Responsibility Guide
• Exhibits to Financial Responsibility Guide

Payment

• Conditions of Payment
• Electronic Spreadsheet Examples
• General Reimbursement Request Information
• Reimbursement Request Examples
• Reimbursement Request Instructions and Checklist

Technical

• Bid Summary Sheet
• Cost Guidelines
• Cost Guidelines Errata Sheet
• Cost Preapproval Form
• Introduction to Pay for Performance

( Updated 8/28/08 )