Forms

  • For best results, use the current version of Adobe Acrobat Reader.
  • Forms that are marked with a Y in the Fill column can be completed on-line through Adobe Acrobat Reader.
  • Users with Adobe 6.0 and above will need to change a setting before completing the forms so that the tabbing order works correctly. Open Adobe Acrobat, go to the tab on top labeled Edit, go to Preferences, and Accessibility. Make sure the box Use document structure for tab order when no explicit tab order is specified is not checked.
  • Select the appropriate form and click in the first text box to be completed.
  • Enter the required information and tab over or click on the next text box to continue completing the form.
  • Dates must be entered in the following format: mm/dd/yyyy.
  • When printing a form from Adobe Acrobat, the Page Scaling needs to be set to None. This can be found under File, Print, Page Handling Section. There will be a section called Page Scaling with drop down options. Please select None from those options. If any of the other options are selected, additional white space will be added to the margins of the form and the form will shrink.

Department of Health - Internal Form(s)

SFNTitleSizeDateFillable
7054 Authorization for Registration of Antifreeze 335 kb 09/06/2012
Y
8387 Request for Reimbursement – Abandoned Motor Vehicle Program 251 kb 06/19/2012
Y
8399 Release of Abandoned Motor Vehicle/Scrap Metal – Abandoned Automobile Program 323 kb 06/19/2012
Y
16932 Underground Storage Tank Closure 386 kb 06/19/2012
Y
19269 Application for a Solid Waste Management Facility Permit 974 kb 06/19/2012
Y
19534 Permit-By-Rule Notification 519 kb 06/19/2012
Y
50278 Inert Waste Disposal Variance Application 338 kb 06/19/2012
Y
50336 Soil Monitoring Results for Land Treated Petroleum Contaminated Soil 215 kb 06/19/2012
Y
50912 Child Passenger Checkup 765 kb 12/15/2011
N
51098 Waste Disposal Variance Application 349 kb 06/19/2012
Y
51450 Emergency Waste Disposal Variance Notification 246 kb 06/19/2012
Y
51601 Land Treatment Variance Application 631 kb 06/19/2012
Y
51746 Request for Authorization to Sell Bulk Antifreeze 234 kb 06/19/2012
Y
53326 Inert Waste Landfill Annual Report 483 kb 06/22/2012
Y
54097 Application for Concrete/Asphalt Recycling Facilities 392 kb 09/03/2013
Y
58750 Land Treatment Annual Report 324 kb 06/19/2012
Y
59226 Request for Responsibility Exemption/Regulatory Assurance 452 kb 06/19/2012
Y
60120 Waste Rejection Report 365 kb 08/20/2012
Y