Agrichemical Cleanups: Reimbursement Information and Packet

​​​​​​​​Reimbursement Application Packet

Applications for reimbursement should be submitted by email to sally.ballweg@wisconsin.gov. Please be sure all documents are in the correct order prior to scanning and emailing them to us. Please contact us with any questions; we are happy to help.

Download entire packet

Download individual forms:

• Checklist
  
• Overall general instructions (for form numbers: 330, 331, 335, 337, and 340)
• Application cove​r sheet (#330):​ Fillable Word file | PDF
  
• Notification form (#340): Instructions | Fillable Word file | PDF
  
• Multiple responsible person form (#335): Fillable Word file | PDF
  
• Total reimbursement costs form (#331): Fillable Word file | PDF
  
• Insurance information form (#337): Fillable Word file | PDF​
  
• Internal Revenue Service W-9 Taxpayer Identification Number: Instructions and current form available at https://www.irs.gov/forms-pubs/about-form-w-9 | DOA instructions​​

Other Materials

Summary spreadsheet to link invoices to bids and estimates