Part 201 Program Forms and Documents

Contact: Remediation and Redevelopment 517-284-5087

This webpage provides cleanup program information for Part 201.  For Part 213 program additional documents (Informational Memoranda and Publications) go to  If you have any questions on the application of these documents to site specific conditions, please contact the Remediation and Redevelopment Division district office covering your site.


Form No. Title (word) PDF
Part 201 Forms
EQP3900 Notice of Aesthetic Impact Part 201 Yes
EQP4029 Environmental Consultant Affidavit for No Further Action Report Yes
EQP4031 Affidavit of Person Submitting a No Further Action Report Yes
EQP4380 Response Activity Plan to Comply with 7a(1)(b) or 7a(2) Yes
EQP4400 Request for Certificate of Completion from DEQ Yes
EQP4402 Documentation of Due Care Compliance Submittal Form Yes
EQP4420 Response Activity Review Panel Petition Cover Sheet Yes
EQP4028 Request for DEQ Review of Response Activity Plan  
EQP4030 Request for DEQ Review of No Further Action (NFA) Report Yes
EQP4482 Notice of Migration of Contamination   
EQP4506 Public Highway Institutional Control Yes
EQP4507 Certificate of Deposit Yes
EQP4508 Declaration of Restrictive Covenant Part 201 Yes
EQP4509 Escrow Agreement Yes
EQP4510 Financial Test Corporate Guarantee Yes
EQP4511 Letter of Credit Yes
EQP4513 Performance Bond Yes
EQP4514 Postclosure Agreement Yes
EQP4515 Trust Agreement Yes



Financial Assurance Calculators
Financial Assurance Mechanism:  Present  Net Worth (pdf)
Financial Assurance Mechanism:  Present Worth Calculator (xls)