Forms and Applications

For more information regarding PPR guidance documents, please see the Manuals and Guidance page

Document Name and Link	Category
Ballast Water Discharge Form (PDF 120K) A form used to certify that ballast water has not been discharged from a cargo tank of a tank vessel into the waters of the state	Marine Vessels
Change of Ownership (PDF 82K) Change of Ownership Supplemental Form for an Oil Discharge Prevention and Contingency Plan	Contingency Plans
Contingency Plan Application (PDF 244K) Application for approval of an Oil Discharge Prevention and Contingency Plan	Contingency Plans
Contingency Plan Verification Log (PDF 6K) This log is to be completed by terminal facility owners/operators who are subject to the requirements of AS 46.04.030 and 18 AAC 75, Article 4, and who transfer petroleum to or from tank vessels, oil barges, non tank vessels over 400 GRT or rail cars carrying petroleum products as cargo in Alaskan waters	Contingency Plans
Streamlined Plan Application Streamlined Oil Discharge Prevention and Contingency Plan Application for approval and Plan Document	Marine Vessels
Noncrude Oil Tank Vessel or Barge Application Addendum Addendum to be submitted with an application for a Streamlined Plan for noncrude oil tank vessels and oil barges.	Marine Vessels
Financial Responsibility Application (PDF 120K) New and renewal application for financial responsibility	Financial Responsibility
Nontank Vessel Financial Responsibility Application (PDF 103K) Nontank vessel and railroad financial responsibility application with instructions	Financial Responsibility, Marine Vessels
Surface Oiling Permit Permit for applying oil to a road surface for dust control	Permits
Financial Responsibility Surety Bond - Form A (PDF 79K) Contractual form for coverage with state approved suretor	Financial Responsibility
Financial Responsibility Guaranty - Form B (PDF 84K) Contractual form for coverage with parent company or other corporate guarantor	Financial Responsibility
Primary Response Action Contractor Application (PDF 75K) Oil spill primary response action contractor application for registration, for both new application and renewals	Primary Response Action Contractor
Statement of Contractual Terms Form (PDF 12K) Statement of contractual terms between the plan holder and the PRAC, also includes supplemental statement for Trans Alasaka Pipeline System Vessels	Contingency Plans
Facility Location Data Sheet (PDF 221K) This form is to be used to log the collection of location information for applicable regulated facilities and spill sites	Contingency Plans
Transport, Treatment, & Disposal Approval Form for Contaminated Media (PDF 44K) Currently, Alaska Soil Recycling, Inc. (ASR) is the only bonded soil treatment facility in Alaska. As a bonded facility, they are allowed to co-mingle contaminated soil for treatment under their approved facility operations plan. Post-treatment soil samples are collected and analyzed at regular intervals to insure that the contaminants are successfully treated. Because the post-treatment analytical results for co-mingled soils are provided directly to ADEC, the Responsible Party does not have to provide a separate copy of the post-treatment analytical results as indicated in the form	Spill Response
Request for Skimmer System Efficiency Evaluation This form is to be completed by plan holders to make a request to modify the standard effective oil recovery capacity of 20 percent	Contingency Plans
Streamlined Plan Cleanup Contractor Application Streamlined Oil Discharge Prevention and Contingency Plan Cleanup Contractor Application	Contingency Plans
Streamlined Plan Incident Management Team Application Streamlined Oil Discharge Prevention and Contingency Plan Incident Management Team Application	Contingency Plans
Streamlined Plan Incident Management Team Statement of Qualifications Streamlined Oil Discharge Prevention and Contingency Plan Incident Management Team Identified Personnel Statement of Qualifications	Contingency Plans
Streamlined Plan Response Planning Facilitator Application Streamlined Oil Discharge Prevention and Contingency Plan Streamlined Plan Response Planning Facilitator Application	Contingency Plans
Streamlined Plan Notification of Termination or Suspension Use this form to notify the department of a voluntary change to plan status to suspend or terminate a Streamlined plan. Please note that only nontank vessels can suspend a streamlined plan.	Contingency Plans
Streamlined Plan Statement of Contractual Terms – Cleanup Contractor This form is used to verify that a contract is in place between a plan holder and cleanup contractor and is submitted with the Streamlined Plan Application and Addendum for a noncrude tank vessel or barge unless a Response Planning Facilitator is used.	Contingency Plans
Streamlined Plan Statement of Contractual Terms – Incident Management Team This form is used to verify that a contract is in place between a plan holder and incident management team and is submitted with the Streamlined Plan Application and Addendum for a noncrude tank vessel or barge unless a Response Planning Facilitator is used.	Contingency Plans
Streamlined Plan Statement of Contractual Terms – Response Planning Facilitator This form is used to verify that a contract is in place between a plan holder and a Response Planning Facilitator if one is used.	Contingency Plans