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Forms

These forms are available for DEQ land protection activities.

Contaminated Media
Contaminated Media Use Form, Word Format                                       
Contaminated Media Management and Re-use Variance 
Cost Estimate
Landfill Cost Estimate Worksheets CEW-01 and CEW-02, Excel Format
Landfill cost estimate form, DEQ Form CE SWDF, Word Format
SWMF Cost Estimate Memo, Word Format         
SWMF cost estimate form, DEQ Form CE SWMF, Word Format  
Disclosure Statement
Applicant Disclosure Form DISC-01, Word Format
Applicant Disclosure Form DISC-02, Word Format
Applicant Disclosure Form DISC-03, Word Format 
Frequently Asked Questions regarding  the disclosure forms, PDF Format                 
Exempt Yard Waste
Yard Waste Composting Annual Report, Word Format
Exempt Yard Waste Compost Facility Certification, Word Format
Exempt Yard Waste & Herbivorous Manures Compost Facility Certification, Word Format                                
Groundwater
ARSC-01 - Groundwater Annual Report Submission Checklist, PDF Format                         
Groundwater Use Survey, PDF Format
Groundwater Use Survey, Word Format
Hazardous Waste
Application for temporary emergency permit to store or treat hazardous waste, PDF Format  
Recycling
Form DEQ 50-11S ( Recycling Equipment Tax Credit ), PDF Format
Form DEQ 50-11 (Recycling Equipment Tax Certification for Local Tax Exemption), PDF Format
Form DEQ 50-12 ( Waste Motor Oil Burner Tax Credit ), PDF Format                           
Guidance for Certification of Recycling Equipment and Machinery, PDF Format      
Guidance for Certification of Waste Motor Oil Burning Equipment, PDF Format
Form DEQ 50-30 (Locality Recycling Rate Report for Calendar Year 2018), Excel Format
Locality Recycling Rate Report Instructions for Calendar Year 2018, PDF Format             
Regulated Medical Waste
Petition for evaluation and approval of regulated medical waste treatment technology, Word Format
Request for Certification (Local Government), DEQ Form CERT-01, Word Format                              
Special Waste Disposal Request
Special Waste Disposal Request, Word Format
Instructions for Completing SWDR, PDF Format
Solid Waste Permitting
Landfill Mining Application Form, Word Format
SW PTA Part A application form for solid waste management facilities,Word Format
SW PTB Part B application form for solid waste management facilities, Word Format
Permit-by-Rule Application Form, Word Format
Permit application for emergency debris waste piles, Word Format
Form SW-11-1 Local government certification form for solid waste facilities, Word Format
Form SW-11-1 Local government certification form for FFCP facilities, Word Format
DEQ Form SW-11-2, Solid Waste Permit –NOI-Host Agreement Certification from Locality, Word Format
Certificate-to-operate checklist for solid waste disposal facilities, Word Format
SWMF Change of Owner-Operator Word Format
SWIA
Form DEQ 50-25 Reporting table for Solid Waste Information, PDF Format           
Other
Open dump evaluation criteria, Word Format                                                                  
Annual Landfill Underdrain Monitoring Summary (ALUMS) Report, Word Format
Application for Vessel Certificate of Financial Responsibility, Word Format
Solid Waste Annual Permit Fee Quarter Payment Form PF001, PDF Format
Trade Secret Protection Request Form, Word Format
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Virginia Department of
Environmental Quality
P.O. Box 1105
Richmond, VA 23218
(804) 698-4000


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