Application Instructions:

The New York State Department of Environmental Conservation's Voluntary Cleanup Program (VCP) application has five sections. Section I asks for information about the site's location; Section II asks for information about the site's current owner and operator; Section III asks for information about the Volunteer; Section IV asks for information about the site's environmental history over the past 50 years; and Section V asks for information on the Contemplated Use of the cleaned-up site.

The application form is designed to be self explanatory, with the following exceptions:

• Leave the "NYSDEC Site No." space blank. This is for Department use only.
• The Certification must be signed by the Volunteer rather than a representative (e.g., consultant, attorney).
• TYPE OF CONTAMINANTS: Indicate by checking-off the appropriate box(es) whether the known or suspected site contaminants are associated with petroleum only, hazardous substances (including hazardous wastes), manufactured gas plant (MGP) waste, or "other" (e.g., construction and demolition debris). If more than one type is present, check as many boxes as necessary to indicate the contaminant types involved. Clarifications about what is known regarding contaminant types can be provided in Section IV.
• Section I. Site Location. The Voluntary Cleanup Agreement between the Volunteer and the Department needs to contain a clear and legally defensible definition of the "Site." Please provide as much information as needed (e.g., tax map identifiers, area map, site plan, survey drawings, metes and bounds, etc.) to create an unambiguous description of the site boundaries. Regarding the "Street or Route No.", if a precise street address is unavailable, enter a brief direction narrative (e.g., ½ mile north of Clinton & Broadway).

Action on the Application:

The Department will use the information provided on the VCP application form to determine an applicant's eligibility for participation in the Program. It also serves as an initial summary of site conditions.

Applicants should prepare four copies of the application with all attachments, two with original signatures. Two sets, one with original signatures should be sent to:

Chief, Brownfields/Voluntary Cleanup Section
Division of Environmental Remediation
New York State Department of Environmental Conservation
625 Broadway
Albany, NY  12233-7012
HINT: SAVE TYPING - Copy our address from this page, and paste using your word processor. 

The other two sets (one with original signatures) should be sent to the appropriate DEC Regional VCP Coordinator (see the map below)

The Department will attempt to notify applicants whether or not they are eligible to participate in the program within 45 days of receipt of a complete application. If an application is deemed incomplete, the applicant will be notified of the deficiency and may submit the additional information.

Please note that under certain circumstances, a proposal to remediate a site may require an environmental review under the State Environmental Quality Review Act (SEQRA).

For PDF copy of Application Form, click here:

Voluntary Cleanup Application Form

NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION

VOLUNTARY CLEANUP PROGRAM APPLICATION

NYSDEC Site No.:_______________________ (rev. 11/00)

STATEMENT OF CERTIFICATION

I,_____________________________________, do hereby certify and attest that the information included in this Voluntary

Cleanup Program application, including any attachments, is, to the best of my knowledge and belief, accurate and complete; and

that the applicant has the necessary funds to undertake the activities proposed to be implemented under this application, if

approved.

_______________ ____________________________________________________________

Date Signature

TYPE OF CONTAMINANTS: Petroleum Hazardous Substances MGP Other

I. SITE NAME AND LOCATION

SITE NAME (legal, common, or descriptive): _____________________________________________________________

SITE LOCATION: Street or Route No.: __________________________________________________________________

CITY/TOWN: _____________________________ COUNTY: _______________________________ ZIP: ___________

LATITUDE: _________________________ LONGITUDE: __________________________

COUNTY TAX MAP IDENTIFIER NO(S). ___________________________________________

II. CURRENT OWNER/OPERATOR INFORMATION

Current owner's name, address, and phone and fax nos.: Current operator's name, address, and phone and fax nos.:

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

III. VOLUNTEER IDENTIFICATION

Volunteer's name, address, and phone and fax nos.: Volunteer's contact's name, address, and phone and fax nos.:

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

Describe Volunteer's relationship, if any, to current owner and current operator (subsidiary, shareholder, partner, etc.). If no

relationship, put "none":

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

IV. PROPERTY’S ENVIRONMENTAL HISTORY OVER PAST 50 YEARS

A. To the extent that existing information/studies/reports/ are readily available to the applicant, attach:

- a description of the environmental history of the site that includes previous uses of the property, types of operation,

chemicals used on the property, by-products or wastes produced by previous activities on-site, and a list of any orders,

decrees, or other legal documents regarding violations of the Environmental Conservation Law or equivalent federal

environmental statutes;

- a list of previous owners with names, last known addresses and telephone numbers (describe Volunteer’s relationship, if

any, to each previous owner listed. If no relationship, put "none"); and

- a list of previous operators with names, last known addresses and telephone numbers (describe Volunteer's relationship,

if any, to each previous operator listed. If no relationship, put "none").