Petroleum Fund Forms
Forms for Changes to Petroleum Fund Claimant
The following templates were developed by Petroleum Fund staff to encourage proper notification for a change in claimant and/or associated authorized representative for corrective action efforts at a facility receiving State Petroleum Fund reimbursement. Each template serves a different purpose, so please review the description below each to ensure proper use. The language in these documents should not be changed. Please fill in the editable fields with the applicable information, print the template on company letterhead, and include actual inked signatures of the people named on the letter. Note, you must contact the remediation case officer in addition to the below Petroleum Fund notice if the responsible party has changed for an ongoing corrective action.
Change of Operator/Claimant
Change of Authorized Representative
CEM Payment Affidavit for Subcontractor Costs
|2015-01 Form I - Contractor Certification|
|2015-01 Form II - Vendor Certification|
|2015-01 Form III - Bid Request|
|2015-01 Form IV - Bid Summary|
|2015-01 Form V - CEM & Contractor|
|2015-01 Form VI - Owner & Contractor|
Petroleum Fund Enrollment Forms
Operators of underground storage tank (UST) systems must register with NDEP's UST Program using the below form prior to enrollment in the Petroleum Fund. USTs will be enrolled in the Fund upon receipt of this form, the enrollment payment ($100 per tank system), and demonstration of system tightness (tanks and associated product piping).