HomeMy WebLinkAboutUNDERGROUND TANK FILE 3KERN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
INVESTIGATION RECORD
OWNER ,~ ~ ~ ~ ~ ~ ~ ADDRESS
ASSESSORS ' PARCEL ~,
CHRONOLOGICAL RECORD OF INVESTIGATION
DATE
KERN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
INVESTIGATION RECORD
ASSESSORS ' PARCEL
ADDRESS
c? / :-D c/!_
DA~E I
CHRONOLOGICAL RECORD OF INVESTIGATION
KERN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
INVESTIGATION RECORD
DBA
ADDRESS ~,'~-, ~
ASSESSORS ' PARCEL
c?/c5-O ~//
CHRONOLOGICAL RECORD OF INVESTIGATION
DATE
MC:cd
TANK
REPORT
JUL 10 1992
1. I have not done any major modif~tions to thi~ facility during t~e
last 12 months // . ' ,,ii {'5 JIM HiNDMA~ Su,w
~ote:All major modiflcatlonCrequl~ ~ Permit' to ~onstrUct from
the Permitting Authorl~.
2. I have done major modifications for which I obtained Permit(s) to
'Construct frOm Permitting Authority
Signature
Permit to Construct # Date
3.Repair and Maintenance Summary
Attach a summary of all:
-- Routine and required maintenance done to this facility's tank,
piping, and. monitoring equipment.
-- Repair of submerged pumps or suction pumps.
-- Replacement of flow-restricting leak detectors'with same..
-- Repair/replacement of dispensers, meters,.or nozzles.
-- Repair of electronic leak detection components, or replacement
with sane.
-- Installation of bail float valves.
-- Installation or repair of vapor recovery/vent lines.
Include the date of each repair or maintenance activity.
NOTE: All 'repairs or replacements in response to a leak require a
Permit to Construct from the Permitting Authority as do all
other modifications to tanks, piping or monitoring equipment
not listed here.
Fuel Changes - Allowed for Motor Vehicle Fuel tanks Only.
List all fuel storage changes in tanks, noting:
Date(e), tank number(s), new fuel(s) stored.
Inventory control monitoring is required for this facility on the
Permit to Operate, and I have not, exceeded any reportable limits aa
listed in the appropriate inventory control monitoring handbook
during the last twelve months (if not applicable, disregard).
Signature
6. Trend Analysis Summary
Please attach Annual Trend AnalySis Summary for the last 12 periods.
7. Meter Calibration Check Form
Please attach current, completed Meter Calibration Check Form
ANNUAL TRI~-ND ~NALYS T $ $ U~RY
TANK
QUARTER 1
PERIOD !:
PERIOD 2:
PERIOD 3:
TIME PER OD:
Total Mlnuses Th£s Perlod (Line 3)
Ac~lon Number ~or thls Perlod (Line 4)
Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
to
/
QUARTER 2
PERIOD 4:
PERIOD 5:
PERIOD 6:
QUARTER 3
PERIOD 7:
PERIOD 8:
PERIOD 9:
QUARTER 4 TIME PERIOD:
PERIOD 10: Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
PERIOD 11: Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
PERIOD 12: Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
Total Minuses This Period (Line 3}
Action Number for this Period (Line 4)
Total Minuses This Period (Line 3)
Action Number ~or this Period (Line 4)
TIME PERIOD: //~/~'~ to
Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
Total Minuses This period (Line 3)
Action Number for this Period (Line 4)
Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
Date
I hereby certi~y this is a true and accurate report.
FAC I L I TY
TANK# ~
C
CONTROL
SHEET
PERMI
COL.
COL. 2
TEST WEEKLY
WEEK SHUT-DOWN
PERIOD
I COL 3
I '
INCHES
TIME
DATE/HR
TO
DATE/HR
DATE/HR
DATE/HR
DATE/HR
TO
DATE/HR
DATE/HR
DATE/HR
6
7
8
9
11
12
DATE/HR 7-2--~- ~; o 0 I
I
DATE/HR 7'J/- ~4 ~,., I
DATE/HR ~*-~Z- 6: ,*o I
· TO I
DATE/HR ~?-/~/' ~ o o I
DATE/HR ~-/~-~.' .~ o I
DATE/HR ~'21'~; 0~
TO
DATE/HR
DATE/HR ~- Z - 6,'3~
DATE/HR q-~' ~ 30
DATE/HR e' I1' ~: ~-' I --
DATE/HR
TO
DATE/HR
I ICOL. 6
COL. 4'COL. 51
2ND IST INCH
iGAUGE -GAUGE = CHANGE
INCHES I INCHES
I
!
I
I
I
I
INCHES
ICOL .- 9 I COL I 0 I
I COL' 8.l I ' I
COL. 7I
2ND _ 1 ST :VOLUME+suBTOTAL:·
VO n Ub~z. VOLUME CHANGE
GALLONS I GALLONS
13
DATE/HR
TO
I DATE/HR
DATE/HR ?-/O-
To /0-2-
[DATE/HR
GALLONS
GALLONS
COL. 11
CUMULATIVE
CHANGE
GALLONS
"' ·- QUARTERLY SUlVllVI~kRY
FILL~ OUT THE FOLLOWI~ REPORTING 'SUMMARY APPLICABLE TO THE TANK NOTED ON REVERSE (CHECK ONE ONLY)·
TANK MONr,'ORED tS A WASTE-OiL OR NON-MOTOR-.VEHICLE FU~.L'~T'~NK'
REPORT TO THE PERMITTING AUTH~RITY'MITHIN 24. HOURS 'IF:
A. VOLUME CHANGE (COL. 9) ,IS +/- 10 GAL~ONS"0R MORE . ~
B. CUMULATIVE VOLUME CHANGe, (COL. 11) IS-+'/~:]0~) GALLONS OR MORE'
f '
{ SUMMARY i
TANK .# , P{ERMIT #
MONITORING BE.I~WEEN DATES OF AND ~
(INCLUDE YEAR) NOTED ON!REVERSE RESULTED IN:
I. A ~XIM~WEE~r~Y I'
VOLUME CHANOE (COL. 9) OF OAL~.
2. A CUMULATIVE VOLUME ~CHANGE (COL. 11, BOTTOM LINE) OF
OALLON~
I HEREBY CERTIFY THAT THE ABOVE-NOTED RESULTS REPRESENT A TRUE AND
ACCURATE REPORT AND='THAT THEY/DO NOT EXCEED THE REPORTABLE' LIMITS
DESCRIBED IN "A" AND "B" ABOVE.
SIGNED
TITLE
DATE
TANK MONITORED IS A MOTOR VEHICLE FUEL TANK
REPORT TO THE PERMITTIN6 AUTHORITY WITHIN 24 HOURS IF:-
A, TANK OF 1000 OALLONS OR LESS CAPACITY HAS A VOLUME CHANOE (COL. 9)
OF +/- 25 GALLONS OR MORE
B. TANK OF 1001 TO 5000 GALLONS CAPACITYHA~ A. VOLUME.CHANOE (COL. 9)
OF +/-35 GALLONS OR MORE ,
C. TANK OF OVER=5000 GALLONS CAPACITY HAS A VOLUME cHAN~E'"(COL. 9):.
+/- 50 GALLONS OR MORE :. ~
D. ANY'TANK HAS:A CUMULATIVE VOLUME CHANGE (coL'. ]i)..OF'i',~/~'. 250 GALLONS
OR MORE-OVER~ THE QUARTER TIME FRAME REPRESENTED' ON REVERSE
- SUMMARY
....MoNIToRi'NG"BETWEEN' DATESi O~ V~/~! ' ' AND' ~-~
· (INCLUDE YEAR) NOTED ON REVERSE RESULTED 'IN:'
" !'. 'A MAXIMUM WEEKLY VOLUME CHANGE (C~L. 9') OF... : !)::.: GALS.
2. A CUMUL~IVE VOLUME CHANGE (COL. :ll,"~BOTTOM'LINE)' OF
GALLONS
I HEREBY CERTIFY THAT THE ABOVE-NOTED RESULTS REPRESENT A :TRUE AND
ACCURATE REPORT AND THAT THEY DO NOT EXCEED THE REPORTABLE.LIMITS
DESCRIBED IN "A" THROUGH "D" ABOVE.
¢
DATE'
JiM HiNDMAr,{, S.upv Mecn i~
~neral SerVices · Garage Divi~ior,.
SUBMIT A COPY OF THIS SUMM~Y WITH FACILITY ANNUAL REPORT
RETAIN THESE RECORDS AT THE PERMITTED FACILITY FOR A MINIMUM OF THREE YEARS
MODIFIED ~NVENTORY CONTROL
SUBSTANCE STORED ~ ~ / g ~J* J
SHEET * ~
QUARTER/YEAR ~ C'-/-- -- J~¢ c
COL. 1
TEST WEEKLY [WATER
WEEK SHUT-DOWN } LEVEL
1
2
COL. 311COL' 41COL' '511
[ 2ND 1 ST
I GAUGE -GAUGE --
TIME PERIOD [ INCHES [ INCHES I INCHES
DATE/HR
IDNrE/HR 10-2~-&:~ I ~ I
I TO /0-2] ~"~*1 I ~
I DATE/HR ! ~ I
4
IDATE/HR
I ?o
[DATE/HR
5
6
COL. 6
INCH
CHANGE
7
INCHES
8
I
I
I
I TO ~,.o.~I i ~:::~--- I
I
I
I
11
IDATE/HR TO
I DATE/HR
IDATE/HR
TO
DATE/HR
12
IDATE/HR [2-3o- &: ~
[DATE/HR
I
ICOL 8 COL. 9
COL. 7I . .
2ND IST VOLUME _uBTOTAL:
IVOLUME-VOLUME =CHANGE+~
GALLONS GALLONS
13
I
I
I
I
!
I
COL. 11
CUMULATIVE
CHANGE
I
GALLONS
GALLONS
I
I
I
I
!
V
~'1
I
I/
I~'1
I
I
GALLONS
'~¥ oUARTERLy S UlVllVi;%R Y
FILL OUT THE '- '-"': ~:' "'
... . FOLLOWING REPORTING SUMMARY'-'APPLICABLE TO THE TANK NOTED ON REVERSE (CHECK ONE ONLY)
TANK MONITORED IS A WASTE-OIL! OR NON-MOTOR VEHICLE-FUEL TANK`·.,
--\
REPORT TO THE PERMITTING AUTHORITY WITHIN 24 HOURS IF:
A. VOLUME CHANGE (COL. 9) IS +/- 10 GALLONS--OR MORE
· B. CUMULATIVE VO.LUME CHANG{E' (COL."" 11')... IS" +/-; 100 GALLONS~':OR MORE-'
GALS.
TANK #" '...~ PERMIT # '
MONITORING Bi~TWEEN DATE~ OF AND
(INCLUDE YE.AR) NOTED ONI REVERSE RESULTED IN:
1. A MAXIMUM WEEKLY VOLUME CHANGE (COL. 9) OF
2. A CUMULATIVE VOLUME CHANGE (COL. 11, BOTTOM LINE) OF
: ;.. GALLONS. :
I HEREBY CERTIFY THAT THE ABOVE-NOTED RESULTS REPRESENT A TRUE AND
ACCURATE REPORT AN[~'THAT THEY DO NOT EXCEED THE REPORTABLE LIMITS
DESCRIBED IN "A" AND "B" ABOVE.
SIGNED
TITLE
DATE
TANK MONITORED IS A MOTOR VEHICLE FUEL TANK
REPORT TO THE PERMITTING AUTHORITY WITHIN 24 HOURS IF:
A. =TANK OF 1000 OALLONS OR LESS CAPACITY HAS A VOLUME cHANOE (COL. 9)
· OF +/- 25 GALLONS OR MORE
B. TANK OF 100! TO 5000 GALLONS 'CAPACITY HAS: A'VOLUME CHANGE (COI;. 9)
.OF. +/- 35 GALLONS OR MORE
C.- ~TANK OF OVER 5000 GALLONS CAPACITY HAS A VOLUME CHANGE ~(COL. 9)
+/- 50 GALLONS OR MORE
D. ANY TANK HAS A CUMULATI .YE VOLUME CHANGE (COL':' '11 ,.,?='+/~ 250 GALLONS
OR MORE OVER THE QUARTER TIME FRAME REPRESENTED ON "REVERSE.
~' SUMMARY ........ .... ...
· MONITORING BETWEEN DATES OF
( INCLUDE YEAR) NOTED ON'REVERSE RESULTED IN: '
A XIMUM WEEKLY VOLUME CHANGE (COL-. 9)-OF'-'-': .-ii': GALS.:.'.
2. A CUMULAT.~I-iVE VOLUME CHANGE (COL. 1~, BOTTOM LINE)OF
I HEREBY CERTIFY THAT THE ABOVE-NOTED RESULTS' REPRESENT A 'TRUE AND ·
ACCURATE REPORT AND THAT THEY DO NOT EXCEED THE. REPORTABLE LIMITS ..
DESCRIBED IN "A" THROUGH "D" ABOVE.
k
SIGNED TITLE ,.:~::eral $.erv~ce$:® Garaoe Divi.~ior,
SUBMIT A COPY OF THIS SUMMARY WITH FACILITY ANNUAL REPORT
RETAIN THESE RECORDS AT THE PERMITTED FACILITY FOR A MINIMUM OF THREE YEARS
~ :~ QUARTERLY
T~K~ ~ CAPACITY 10/ JO 0
MODIFIED ~NVENTORY CONTROL
~'~-..
SUBSTANCE STORED (,I,~L~ ae~
SHEET
II ICOL 91 COL 10 I COL. 11
COL. 1 COL 2 COL 3 coL 41COL 51 COL 6 COL 71 COL- 81 ' I ' I
VOL UME C UMUL AT I VE
TEST WEEKLY WATER 2ND 1 ST INCH ] 2ND 1 ST =CHANGE+SUBTOTAL:
WEEK SHUT-DOWN LEVEL GAUGE -GAUGE -- CHANGEIVOLUM~--VOLUME CHANGE
· TINE PERIOD INCHES INCHES I INCHES INCHES [ GALLONS GALLONS GALLONS GALLONS [ GALLONS
P~- ~.'oo ' o
2
3
DATE/HR
TO
DATE/HR /-~' 6:O0
TO
DATE/HR
4
5
6
.7
8
9
DAT,~./HR 122- ~ :~ CFC)'
DATE/HR
DATE/HR
DATE/HR
TO
DATE/HR
DATE/HR ,,7' 2-- (~:
TO ,
DATE/HR 7-~-~,
DATE/HR-:~" 9-' ~:: ~ ~
I
I
I
I
12
TO
DATE/HR
DATE/HR ~- I ~
TO
DATE/HR
DATE/HR ..~-2f' 6: o 0 I'
TO I
i DATE/HR .~-25-- ~' oo !
13
IDATE/HR 7-3o-~:30 I '
I TO
IDATE/HR "/-1-
6"°°1
I
I
I
I I
I
I
TANK MONITORED IS A WASTE-OIL~ OR NON-MOTOR VEHICLE FUEL TANK~
. ,, ',,' O'UART.ERLy sultry
FILL OUT THE'FOLLOWING RE~oRTiNG SUMMARY APPLICABLE'TO THE TANK NOTED ON REVERSE (CHECK ONE ONLY)
REPORT. TO THE PERMITTING AUTHORITY WITHIN 24 'HOURS IF:
'A. VOLUME CHANGE (COL. 9) lis +/- 10 GALLONS OR MORE.
B. .-CUMULATIVE VOLUME CHANGE (COL. ,11) 'IS-"+/'~ 100 ~ALLONS OR MORE
'j.¢ { ... ,.
A CUMULATIVE VOLUME CHANGE (COL. 11, BOTTOM LINE) OF
GALLON'S ~-?
, SUMMARY
........... TANK # "~.. PERMIT # ....
MONITORINO BETWEEN DATES OF AND
(INCLUDE YEAR) NOTED ONREVERSE RESULTED IN:
1. A xIMU , EEKLY VOLUME. CHANGE (COL. 9) OF
GALS.
,I HEREBY,CERTIFY THAT-THE ABOVE-NOTED RESULTS, REPRESENT A TRUE AND
ACCURATE REPORT AND~:'THAT THEY DO NOT EXCEED THE REPORTABLE LIMITS
DESCRIBED IN "A" ,AND "B" ABOVE.
S I GNED '<':='
TITLE
DATE
TANK MONITORED IS A MOTOR VEHICLE FUEL TANK
REPORT TO THE PERMITTING AUTHORITY WITHIN 24 HOURS IF:
Bo
Co
TANK OF 1000 GALLONS OR LESS CAPACITY HAS A VOLUME CHANGE (COL. 9)
OF +/- 25 OALLONS OR MORE
TANK'OF 1001 TO 5000 OALLONS CAPACITY HAS A'VOLUME cHANGE (COL. 9) '
OF +/- 35 GALLONS OR MORE ':'"
TANK OF OVER!5000 GALLONS CAPACITY HAS A VOLUME CHANOE (COL. 9)
+/- 50 GALLONS OR'MORE - ' : .... ' ~'- '"'": -
ANY TANK HASJ A CUMULATIVE VOLUME CHANGE (COL." 11)~OF:'¥/~ 250 GALLONS
OR MORE OVER THE QUARTER TIME FRAME REPRESENTED ON/REVERSE.
SUMMARY '- ' .-
(INCLUDE YEAR) NOTED ON ~EVERSE RESULTE~ IN: --~ --
A ~XIMUM WEEKLY VOL~E CH~GE (COL'.- 9) OF GALS. ".-'-
A C~LATIyE VOL~ C~NGE (COL. :~ BOTTOM LINE) OF
I -HEREBY CERTIFY THAT THE ABOVE-NOTED RESULTS REPRESENT'A TRUE_ AND
ACCURATE REPORT AND THAT THEY DO NOT EXCEED THE REPORTABLE..Li'MITS
DESCRIBED IN "A" THROUGH "D" ABOVE.
SUBMIT A COPY OF THIS' SUMMARY WITH FACILITY ANNUAL REPORT
RETAIN THESE RECORDS AT THE PERMITTED FACILITY FOR A MINIMUM oF THREE YEARS
TITLE
DATE
~ ~ (~UA]~TERLY ~IODI FI ED ~ NVENTORY
FACILITY d-__Joo~';~,f oJ" /~.~,'r',-'. "J V,,..,~ 0"
TANKS' ~- CAPAC I TY /~ c-o ~
SUBSTANCE
CONTROL
COL. 1 I COL 2
I '
TEST
WEEK
HUT -DOWN
Il IcoL $ I
COL. 3 COL. 4I '
WATER I 2ND 1ST
LEVEL IGAUGE GAUGE
TIME PERIOD INCHES
I TO
IDATE/HR/-/-;-7- (:-~ o
I ~
3
4
y I
5
6
8
9
lO
121.
IDATE/HR 5"--,./- ~"'~1
I
t DATE/HR ~'-
DATE/HR ~ //
TO ~-ij. coo
DATE/HR
DATE/HR ~-/~-
~'-2 o-~,: o~,
DATE/HR
I
DATE/HR
TO
DATE/HR
DATE/HR
DATE/HR
To ~-/7-~'.'~ ~
DATE/HR
DATE/HR
TO
DATE/HR
i DATE/HR ~ ~/-~'~ g
TO
DATE/HR
INCH
C HANG E
INCHES INCHES INCHES GALLONS
COL 7 I COL 8 ICOL 9 I COL 1 0 I COL- !
2 ND 1 S T VOL UME
=CHANGE+SUBTOTAL: C UlVIULAT I
VOL UMW- -VOL UMW-- C HANG
I
c/~¢ q I
I
, I
GALLONS GALLONS
GALLONS I GALLONS
!3
· ' .. ' ....... QU,~i{TERLY SUI~IlW_,i, RY
FILg OUT THE 'FOLLOWING RE~'oR~!NG..S_uMNARY APPLICABLE TO THE TANK NOTED ON REVERSE (CHECK ONE ONLY)
TANK MONITORED IS A WASTE-OIL OR NON-MOTOR VEHICLE'FUEL TANK
REPORT TO THE PERMITTING AUTHORITY WITHIN 24 HOURS IF:
A. VOLUME CHANGE (COL. 9)" IS +/- 10 GALLONS'OR MORE
B. CUMULATIVE VOLUME CHANGE (COL' 11) IS +/- 100 GALLONS OR MORE
TANK
SUMMARY
PERMIT #
MONITORING BETWEEN DATES OF AND
(INCLUDE YEAR.) NOTED QN REVERSE RESULTED IN:
1. 'A MAXIMUM-i. WEEKLY VOLUME-CHANGE (COL. 9) OF
2. A CUMULATIVE VOLUME CHANGE (COL. 11, BOTTOM LINE) OF
GALLONS
I HEREBY CERTIFY THAT THE ABovE-NOTED RESULTS REPRESENT A TRUE AND
ACCURATE REPORT AND THAT THEY DO NOT EXCEED THE REPORTABLE LIMITS
DESCRIBED IN "A' AND "B" ABOVE.
GALS.
SIGNED TITLE
DATE
TANK MONITORED IS A MOTOR VEHICLE FUEL TANK
REPORT TO TItE PERMITTING AUTHORITY WITHIN 24 HOURS IF:
B.
C.
D.
TANK OF 1000 GALLONS OR LESS CAPACITY HAS A VOLUME CHANGE (COL. 9)
OF +/- 2§ GALLONS OR MORE
TANK OF 1001 TO 5000 GALLONS CAPACITY HAS A VOLUME CHANGE (COL. 9)
OF +/- 35 GALLONS OR MORE
TANK OF OVER 5000'GALLONS CAPACITY HAS A' VOLUME CHANGE (COL. 9)
~/- 50 GALLONS OR MORE '
ANY TANK HAS A CUMULATIVE VOLUME CHANGE {COL. 11) OF +/- 250 GALLONS
OR MORE OVER THE QUARTER TIME'FRAME REPRESENTED ON REVERSE.
SU~,RY
TANK # ~ PERMIT
(INCLUDE YEAR) NOTED ON REVER~ RESULTED IN:
1. A ~xIMUM WEEKLY VOLU~E CHANGE (COL..9) OF $9/ ' GALS..
2. A CUMULATZVE VOLUME C,ANGE (COL. ~l, BOTTOM LZNE) OF
· ~ GALLONS
I HEREBY CERTIFY THAT THE ABOVE-NOTED RESULTS REpRESENT-A TRUE. AND
ACCURATE REPORT AND THAT THEY DO NOT EXCEED THE REPORTABLE LIMITS
DESCRIBED IN "A" THROUGH "D' ABOVE.
TITLE ,.~J~neral Ge~wces-Garag~ Divi~k~,
DATE '77,~.~, ~
SUBMIT A COPY OF THIS SUMMARY WITH FACILITY ANNUAL REPORT
RETAIN THESE RECORDS AT THE PERMITTED FACILITY FOR A MINIMUM OF THREE YEARS
Facility
1.
T~K FACILITY ~u'~INU~L REPORT
I have not done any major mo~ft0atlons to this facility du~tng the
last 12 months. ///~ //~/~~/ . JIM HiNDk~AN. ~pt,' Mech i:
Signature' ~ --c (~ ~- -- '/ , =e~eral Se~'wces~
Note: Ail major modificat~ns require a Permit to Construct from
the Permitting Authority.
I have done major modifications for which I Obtained Permit(s) to
Construct from Permitting Authority
Sifnature
Permit to Construct
Repair and Maintenance 9unmary
Date
/
A~ch a summary of all:
-~ Routine and required maintenance done to this facility's tank,
piping, and monitoring equipment.
-- Repair of submerged pumps or suction pumps.
-- Replacement of flow-restricting leak detectors with same.
-- Repair/replacement of dispensers, meters, or nozzles.
-- Repair of electronic leak detection components, or replacement
with same.
-- Installation of ball float valves.
-- Installation or repair of vapor recovery/vent lines.
Include. the date of.each repair or maintenance activity.
NOTg: All repairs or replacements in response to a leak require a
Permit to Construct from the Permitting Authority as do all
other modifications to tanks, piping or monitoring equipment
not listed here.
Fuel Changes - Allowed for Motor Vehicle Fuel tanks Only.
List all fuel storage changes in tanks, noting:
Da(ets), tank number(s), new fuel(s) stored.
Inventory control monitoring is required for this facility on the
Permit to Operate, and I have not, exceeded any reportable limits as
listed in the appropriate inventory control monitoring handbook
during the last twelve months (if not applicable, disregard).
Signature
6.. Trend Analysis Summery
Please attach Annual Trend AnalySis Summary for the last 12 periods.
?. Meter Calibration Check Form
Please attach current, completed Meter calibration Check Form
INYO ST. REPAIR HZSTORY
TANK {! & 3 PERMI'T {ZSOOl/C
YEAR PERIOi)
.._~ ............ ..U...A._T_,S_ ...... i_.l ........................... _W_0B.K__._C.O_~_~_I...~_!_'~_~ ................................................... i...__~_~_V_:__{.. ....
....... 5./_0.. ~Z~_z_ _..3__~_e_..p...Z.. ,a_c.~ __b...a..~_ =~_o_c...~_ _a.~_ .s_e._u_~.b_~.~_. j_.~_ _~_~ ] _~ ~ .................. [_._s_.~_~ 'j_~ ...........
........ . ~...J._2_ .8,. _/.~_~_ ~....~._~ e__a__n. __a..Q~_ ~ u b ~ .__K...e.~..!.o_ ..c...K_. _s.~.. _s_ .t:.e..~. ............................................................. ~.~_~_~...6. ........
...... ~/_~_'L ./_~_~..__ J__'.~'.~ :~..n_ _.~_~ .~.r_._~_u_ ..~.~ _..~_~_o_~_~_o_u.~_h_~..o, _..~Lo.x.t. :_h__.t.~_n_.~.._ .......... l.._.S...5~_~..O_ ............
............................... j
I
..... "?'¢' ........ :~ ........... ~'*'"' ;'" '" ' "' ,"; :SupPlies"
nplete& '¢Saies:~&x L~ '.~;'.?~;~; ,::;':.. ,~'` : ';" 7:'
~AY FRO VOICE2~ERMS:'~Nei~sue;u~on"BeCeipt'~'.'~'~-;%;'' ;ipEEASE:;~C'" ' '. ,RLW EQUIPMENT ; "" ,,,~;,, ':
-;' '~ . --" .'--- -',' ;:4;.:'..-Finance. Cbarge.o~,:2~ per Month v>'.' ~=~IT"T~ ".' P.O 'BOX 640 '
~.-'. · ' ' · : . '~' ".'. '., ;. · ~- ',~'~; .:;'..~. ':.. ",, .,,," ..' '-~v~ ~.~,~;
...... ' ' ' ' ' · '- : ~ . ~,- '-L after~0day~'-.'~ ~ A.-.*'. '" .' :%;: , · .- ; '-; ~,.,'~?~-;~-;¢ BAKERSFIELD; CA 9~0~; .
s
:AUTHORIZED BY '
CRXSRA~ SSRVZCss.~ UAZ~TS'~A~CS
1415TRu!IUN AVSNUI~ ..'. '.
BAKRRSFIBLD, CALIFORNIA 93301
-Facility #587
lnyO.& ChiCo
Bakero£teld '*
/-, ICUSTOMER ORDER NUMBER
TERMS:
NET 30 DAYS
REPAIR O~DER NUMBER . '. INVOICE DATE
cV][ '1:3960 0717-':: 0'8t28/91
~Custoaer reported keylock Vould.:not acttva~
for needed-'repatre - cleaned-and sprayed.v:
RetUrned to Joba~te to replace keyloek . n~
NO PARTS' "~-
.- _(:Va te,;~hn~'tctan'
vtXl order Part
customers unto
n.~.n 8 ."properly .(.-'
....
~'.. '.. '~...'}:.. :" . . ~ ..'.'
' -: . . . - . .....
.f:'=: ...: ~..~... ,: · -:.,;:
. -.
CONDITIONAL SALES AGREEMENT:' Tide t~eii'ab0ve ehumerated prope'ty ~hall re~aln /',
wholly In CAL-VALLEY EQUIPMENT CO.; until ~ald. ~ and vendee ~all ~d~ ~e on
demand If In default on paymen~ It II ell~ e~ ~ i~ ~oll~flon I~.m~e by su~ o[ o~'
wise, I/we agree tO pay In~ until ~lly pa~d; ~.~lm~~ Ip~l'ret~ ~ In~ ~ month -..
a~er 30 day~ ~ collation ~o~, including ~ney~.f~ ~' ma~ be ~dJud~ by c~. and
waive all ri~a to anv claims ~mpt~ und~ S~te La~;' and.will not rem~e p~p~ ~hout.
.wrl~en consent of CAL*VALLEY EQUI~.N.T
. ' '...: ~.... ~;,-~ . ~' .'~ r ~.~?~.:~..j/'~¢; · ' .
-"' '"- "" '" .... ' .CASH DIS(~OuNT IF
TOTAL
THIS INVOICE IS PAID BY.'
- NO STATEMENT ISSUED UNLESS REQUESTED.'·
84. O0
N~.V.~O ICE. N~
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, Q~Y .PART NO~ ~ ~ ..... = .... ~.::,~.,~ ...... "~ ~. DESCRIPTION '.~ ........... ~ .... ."~'". . *'-.. '.' · ~ :', ~*~:' '.~ , .... .....
- '~". ' '": ,?' '.~.'?~:' ::~:;-?,',G:~ ,.67~~' :~::*~.'.'~;:"~?~~: '-,":'~-**' ,~-' ~,~ ' :. ' ~ ....... ". '.'" :':,~' , . ' · ' .....
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:~ate,~mpmted? echni.~:~:~::~.?~.r¢'~?,~:~7~;,?,.~~:'s ::~l~Tax ~ .~ '.' :". .... ,." ..,, . '...' ~, :'
TANK
QUARTER 1
PERIOD !:
PERIOD 2:
PERIOD 3:
~INUAL
TREND ~LNALYSXS
7/' I, t
Total Minuses Th£s Period (Line 3)
Action Number for this Period (Line 4)
Total Minuses This Period (Line 3)
Action Nunber for this Period (Line 4)
Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
S UNle~RY
!
QUARTER 2
PERIOD 4:
PERIOD 5:
PERIOD 6:
Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
Total Minuses This Period (Line 3) 7 0
Action Number for this Period (Line 4)
Total Minuses This Period (Line 3)
Action Number for this Period (Line 4) /{9/
PERIOD 7: Total Minuses This Period (Line 3)
Action Nunber for this Period (Line 4)
PERIOD 8: Total Minuses This Period (Line 3)
Action Number for this Period (Line 4) /~
PERIOD 9: Total Minuses This Period (Line 3) /~
Action Nunber for this Period (Line 4)
QUARTER 4
PERIOD 10: Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
PERIOD 11: Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
PERIOD 12: Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
TIME PERIOD:
(
I,-tl
!?~,
I hereby certify tills is a tru~ and accurate report.
Stsnature ? JIM ' e '
HINDMAN,$upv M cn P
~ ~.~eral Secv~ces · Garage. Div~ior,'
Date
KERN
~NTY
TREND ANALYSI ~
.TANK # / CAPACITY /0~ 0O 0 PROOUCT O~Ce-J*J YEAR/PERIOD
I NSTRUCTI ON'S :
PART A : OVERAGE/SHORTAGE Fill in all information at top
form. In the space for year/
1 16 period indicate the year and th(
DAY DATE (+/-) consecutive period of analysis
DAY 1 -~__/..~_ { .... being conducted (from 1 througl
DAY 2 y.~-.')y --~ 12 only). Transfer the date an¢
DAY 3 ~-~'-~! ~ the sign from columns 1 and 16
DAY 4 ~.-~- ~ ~ ~ Reconciliation Sheet to columnl
DAY 5 7~-~[ ~_ , at left. Use the table below t~
DAY 6 ~-~-~ -~ determine the action number fo~
DAY 7 ~--~1~ ~--~ ~ the period be in8 analyzed.
DAY 8 !
DAY 9 ~-~-5{ ~ ACTX ON NUMBER
DAY 10 ~-/~-~j ~ TABLE
DAY 12 /'1~- ~1 ~ ... 30~DAY } ACTION
DAY 18 ~-]~'~l ~ ,PERIOD NUMBERI NUMBER
DAY 14 7-1~-~) ~ ~1 = 20
DAY ~5 7-/~fll ~ I 2 =
DAY Z6 ~-/~'~l ~ , 3 = 54
ray
DAY 18 ~ -1~-,~ / ~ 5 = 85
DAY 19 ~-/~-~/ ~ 6 = ~0~
~AY 20 ~-~ql ~ ~ = ~ .,
DAY 2Z ~-~*~t ~ 8 = ~33
DAY 22 ~.~-~/ ~ 9 = 149
DAY 23 7-~- ~1 -~ l0 = Z65
DAY 24 7-~ ~-~/ ~ 1Z = 180
DAY 25 7-~-91 ~ 12 = 196
DAY 26 7-~f,-ql
DAY 2~ '~-~7-~1~ Circle appropriate period and
DAY ~8 ~,~-~/ ~ action number, A full cycle
DAY 29 ~.~-~/ ~ made up of periods 1-12, after
DAY 80 7-~.-~[ ~ which a new cycle begins, Use
TOTAL MINUSES {~ Information to complete Part B,
PART B: ACTION NUMBER CALCULATION
Line 1.
Line 2.
Line 3.
Line 4.
Line 5.
Total minuses this period-Part A ............
Cumulative minuses from previous periods in thi's cycle.
Total minuses (add lines 1 & 2) .............
Action~ number for this period (from table ~bove) . /
Is line 3 greater than line 4? ~Yes
If Yes, you have ~ reportable loss and must begin
notification and investigation procedures as described
in Kern County Health Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING".
Env. Health 580 4113 1016 (6/86)
II
KERN
COUNTY
TREND ANALYSI ~
.TANK # I CAPACITY /~ o~ PRODUCT u~L¢~de~ YEAR/PERIOD
I NS T RU~TI ON-S :
PART A : OVERAGE/SHORTAGE Fill in all information at top o!
form. In the space for yeart
1 16 period indicate the year and the
DAY DATE (+/-) consecutive period of analysim
DAY 1 7'Jl-~l -~ .. being conducted (from 1 throug{
DAY 2 ~-/~ 9/ ~ 12 only). Transfer the date an~
DAY 3 ~-2-~1 ~ the sign from columns 1 and 16 o!
DAY 4 ~7.~/ ~ Reconciliation Sheet to column~
DAY 5 ~-~-~) -~ at left. Use the table below tc
DAY 6 .~-_5'- ~/ - determine the action number foz
DAY 7 ~-.~q), -~ ,,, the period being analyzed.
DAY 8
DAY 9 ~-~-'%1 " ACTI ON N U~BER
.,DAY 10
,,DAY 11 ~-/~-~, ~ "
DAY 12 ~-tl- ~1 ~ 30-DAY { ACTION
DAY 13 ~-/~-~/ ~ PERIOD NUMBER{ NUMBER [
DAY
D~Y 16 ~'~/~-~l ~ 3 : 54
DAY 17 ~'./~ -~{ ~ 4 : 69
DAY 19 ~=/~-~/~ ~ 6 = 101
.... DAY 20 ~/ ~-~/ ~ , 7 : 117
DAY 21 ~~/ ~ ' 8 = 133
DAY 22 ~/~/ ~ 9 = 149
DAY 23 ~-~-51 ~ 10 = 165
DAY 24 ~-2~-~/ ~ 11 = 180
DaY 25 ~'~'~ ~ ......... : ..... 12 : 196
DAY 26
DAY 27 ~-q/ ~ Circle appropriate period and
DAY
DAY 29 ~-~/ - - ma~e up of periods 1-12, after
DAY 30 ~-~/ ~ which a new bycle besins. Use
TOTAL MINUSES / ~ information to complete Part B.
PART
Line
Line
Line
Line
Line
B: ACTION NUMBER CALCULATION
1. Total minuses this period-Part A ............
2. Cumulative minuses from previous periods tn this cycle.
Total minuses (add lines 1 & g) .............
Action~ number'fo~r this period (from table above) . /
Is line 3 greater than line 47 ~Yes
If Yes, you have a reportable loss and must begin
notification and investigation procedures as described~¢~f~j$
in Kern County Health Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING". P
Env. Health 580 ~1~ 1016 (6/86)
KERN
TREND ANALYSIs
~'AC I L I TY C Ou~,-r~/ ~ /~'~ /a,~O £~. PERMI T #
TANK $ / CAPACITY/ ! O. O 0 l) FRODUCT (~Y~m Lt~e cl YEAR/PERIOD
INSTRUCTION'S:
PART ~ : OVERAGE/SHORTAGE Fill in all Information at top ol
form. In the space for year,
1 16 period Indicate the year and th~
DAY DATE (+/-) consecutive period of analyslt
DAY 1 ~7f~-~/ . being conducted (from 1 throug{
.DAY 2. ~-~/~f ~ 12 only). Transfer the date an(
DAY 3 ~-/ ~! ~ the sign from columns 1 and 16 ol
DAY 4~L~I -/- " Reconciliation Sheet to columm
DAY 5 ~-~-q/ ~ at left. Use the table below t,
DA.Y 6 .... ~-~-61 ' ~ determine .the action number fo]
DAY 7 ~-~T~:/ ................ the period being analyzed.
,DAY 9 ~-TT~,, ~- ACTI ON NUMBER
DAY 10 ~-~"~1 -- T ABL E
,DAY 12 ~-IO,-~l , ~ , 30LDAY { ACTION
DAY 13 ¢-'~-~! , ~ PERIOD NUMBER{ NUMBER
.... pAY 2~ ,~r 2~-~/, ~ Circle appropriate period and
DAY ~8 ~--~[ , ~ action number. A full Cycle is
0AY 29 ~--~( ~ ~ made up of periods 1-12, af.ter
DAY 30 ~-~,~~ which a new cycle begins. Use
TOTAL N,'INUSES ,, ~ Information to complete Part B~,
PART B: ACTION NUMBER CALCULATION
Line 1. Total minuses this period-Part A ............
Line 2. Cumulative minuses from previous periods in this cycle.
Line 3. Total minuses (add lines 1 & 2) .............
Line 4. Actiow, number for this period (from table 'above) . .. .~
Line 5. Is line 3 greater than line 4? ~]Yes ~o
I_~f Yes, you have ~ reportable loss and must begin
notification and investigation, procedures as described
in Kern County Health Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING".
~v. H~lth 580 4113 1016 (6~6)
TREND ANALYSI ~
TANK # / CAPACITY-- / O, 0 0 0 PRODUCT U~ Ce ~ J ~ d YEAR/PERIOD
I NSTRUCTI ON'S :
PART A :'OVERAGE/SHORTAGE ~'~';'~ '" " Fill in all lnfocmation at top o:
form. In the space for yea-r,
1 16 period indicate the year and th~
DAY DATE (+/-) consecutive period of analyat~
DAY 1 ~.-'~-81 -~ being conducted (from 1 throug{
DAY 2 ~-~.O-5!. ~ 12 only). Transfer the date an~
DAY 3 /~'/'~I ~ . the sign from columns 1 and 16 o~
DAy 4 /O-2-51'~ Reconciliation Sheet to column~
DAY 5 /0-/-5/ ~ at left. Use the table below t,
DAY 6 /~-~-~ ~ determine the action number fo{
DAY ~ /~-~-~/ ~- the period being analyzed.
DAY 9 /,,-~-~{ ~ ACTI ON NUMBER
DAY 10 ;~ - ~-~1 - TABLE
DAY.. lZ ~ 30-DAY [ ACTION
DAY 13 ]o'Yl'~l ~ PERIOD NU~ER} NU~BER
DAY 18 /O~Y6-~I ~ ; 5 = 85
DAY 20 /O-/g-~/ ~ 7 = 1~7
DAY 21 /p'/9-9{~ 8 = 133
DAY 22 /a-;o-~l ~ 9 = 149
DAY 23 /~-~Y- ~ ~ 10 = 165
DAY 27 /O.-~-~l ~ Uircle au~ro~riate period and
DAY 28 {0~{ ~ action number. A full cycle is
DAY 29 ~0-~7-~[ ~ made up of periods 1-12, af.ter
DAY. 30 /~-2~-~/~ which a new cycle begins. Use
~.OTAL MINUSES { ~. information to complete Part B.
PART B: ACTION NUMBER CALCULATION
Line
Line
Line
Line
Line
notification and investigation procedures
in Kern County Health Department HANDBOOK
"STANDARD INVENTORY CONTROL MONITORING"
Env, H~lth 580 4113 1016 (6/86)
1. Total minuses this period-Part A ............
2. Cumulative minuses f~om previous periods in this cycle.
3. Total minuses (add lines I & 2) .............
4. Action number for this period (from table above) ....
5. Is line 3 greater than line 4? ~]Yes ~o
If Yes, you have ~ .~eportable loss and must begin
as described
{¸3
q- O
'COUNTY
TREND ANALYSI ~
i:"ACI LI TY ~'0U~T? 0~ /~"~'~ /~'l~ /77 PER~,IZ T ~ 13 301IC
TANK # [ CAPACITY / ~), Oo tY PRODU~w LJ~t~J.~. YEAR/PERIOD
"' I NS'TRUCTI'ON'S :
PART A : OVERAGE/SHORTAGE Fill in all information at top
form. In the space for Year,
1 16. period indicate the year and th~
' '.DA~ DATE (+/-) consecutive period of analySi,,
DAY I /~o~'/ ~ ............. ~ being conducted (from I throug]
DAY 2 /0-.~@'~ ~ lZ only). Transfer the date an~
DAY 3
DAY 4 ]y--]-~.] ~ Reconciliation Sheet to column~
DAY 5 ..YY'2 ~{.. ~ at left. ,Use the table below t,
DAY 6 /Y-~-~ { ~ determine the action number fo]
DAY 7 ~/-~-~/ ~ the period belnz analyzed.
DAY 8
DAY 9 I/-~-9, ~ ACTI ON NUMBER
DAY 12 //- ~-~j . ~ 30-DAY { ACTION
DAY 15
DAY 16 //-/3-~; ~ 3 = 54
,,,DAY 27 //-~-~{ ., , Circle appropriate period and
DAY 28 //-2~--~{ ~ action number. A full cycle is
DAY 29 /Y-Z~-q'} ~ made up of periods 1-12, af.teu
DAY 30 ,//'~7-~l ~ ' which a new cycle begins. Use
TOTAL MINUSES /~ information ,to complete Part B.
PART
Line
Line
Line
Line
Line
B: ACTION NUMBER CALCULATION
1. Total minuses this period-Part A ............
2. Cumulative minuses from previous periods in this cycle.
3. Total minuses (add lines I & 2) .............
4. Action-number for this period (from table above) . /
a.o
5. Is line 3 greater than line 4? ~Yes
If Yes, you have ~ reportable loss and must begin
notification and investigation procedures as described
in Kern County Health Department HANDBOOK #UT-lO
"STANDARD INV~NTORY CONTROL MONITORING"
Env. H~ltb 580 4113 1016 (6/86)
COUNTY
TREND ANALYSI 3
. TANK # { CAPACITY/ / 0., ooo ~PRODUCT 0~-,(.~-~~l~d YEAR/PERIOD
" I NSTRUCTI O'N'S :
PART A : OVERAGE/SHORTAGE Fill in all information at top of
form. In the space for year/
1 16 period indicate the year and the
DAY DATE (+/-) consecutive period of analysis
DAY 1 l}-2[i.i5 { ~- ' being conducted (from 1 through
DAY 2 II'?--~-~l -[- 12 only). Transfer the date and
..DAY 3 1{-~-5~ ~ the sign from columns 1 and 16 of
DAY 4 [~-}- q~ ~ Reconciliation Sheet to columns
DAY 5 {~-l-~ .. ~ at left. Use the table below to
DAY 6 ]2'~-~) ~ determine the action number for
DAY 7 ~-~, ~ .. the period being analyzed.
DAY 8 ]
DAY 9 ]~ -' ~-~l -- ACTI ON NUMBER
DAY 10 /2-7-~/ ~' TABLE
,DAY 11 /~-~-~]
DAY 12 /2--~-5{ ~ 30-DAY { AcTiON
DAY 13 /~-YO'~{ ~ PERIOD NUMBER] NUMBER
DAY 15 /2-/~ -~1 ~ 2 = 37
DAY 16 /2- IT- ~/ ~ 3 = 54
DAY 17 /2 '/~- 0/ ~' , 4 = 69
DAY 18 /2'/~--'~1-~ ~ 5 = 85
DAY 19 /2.'~-~/ -- 6 =
..... DAY 20 /~-/7-~] ~ 7 = 117
..... DAY 21 /~-/~'~1 ,, ~ 8 = 133
DAY 22 /~-/~-~1 ~ 9 = ~49
DAY 23 ]Y-20-~I ~ 10 = 165
DAY 24 ]Z.2]' ~i~ 11 = 180
DAY 25 /~ '2~ '~/ ~ 12 = 196 ; '
DAY 26 /~ -~ ~' 7/
DAY 27 /~-~- ~/ ~ Circle appropriate peri.od and
DAY 28 ~-~-'5/ ~ action number. A full cycle
DAY 29 /~-~-~/ ~ made up of periods ,...1-12, after
DAY 30 /2 ~ which a new cycle .b:e~lns. Use
TOTAL MINUSES ]~ information to ,coaplete::'Part B.
PART B: ACTION NUMBER CALCULATION
Line 1. Total minuses this period-Part A ............
Line 2. Cumulative minuses from previous periods in this cycle.
Line 3. Total minuses (add lines 1 & 2) .............
Line 4. Action" number for this period (fro~ table above) . /
Line 5. Is line 3 greater than line 4? ~Yes
%
If Yes, you have ~ reportable loss and Bust begin
notification and investigation pr'ocedures
in Kern County Health Department HANDBOOK
"STANDARD INVENTORY CONTROL MONITORING".
~nv. H~lth 580 4113 1016 (6~6)
'"
TANK ~ ! CAPACITY--
. . . ~ NsTRUCTI"ON'S :
PART ~ : 0VERAGE/SHORTAG~ ~ill in all information at top of
form. In the space for. year/
I 16 period indicate the year and the
D~Y DAT~ (+/-) consecutive period of analysis
~AY .1 /~-~g'~l ~ being conducted (fro~ I through
. ~AY 2 /~-~-~ ~ 12 only.). Transfer the date and
DAY 3 ~2 ,ff~-~ ~
DAY 4 /2-~/-W.I ~, ., Reconciliation Sheet to columns
0AY 5 .~'I~ q~ ~ .. at left. Use the table belo~ to
.DAY 6 :,~:}--~-~ '" , .... deteraine the action number for
' DAY 7 I-ff~ ~ ..... the period beln~ analyzed.
DAY 9 /-ff*~ ~ .~ . . ACTI ON NUMBER
DAY 10 /;'~-~ ~ ~ TABLE
DAy 12 ~Sy-~ ~ + 30-DAY { ACTION
DAY 13 ~- ~ ~ ~ ,PERIOD NUMBER NUMBER
,uAY 18 u = 8u
DAY 2~'/'~]-~) ., ~ Uircle appropriate period and
DAY 28 ],--~'~- ~
DAY 29 /-Z ~" ~ ~ made up of periods 1-12, af.ter
DAY 30 /'~ g-~- ~ which a new cycle beRins. Use
TOTAL MINUSES ~,,~ in,,for~atlon ,to ,complete P~r$ B.
PART B:
Line 1.
Line 2.
Line 3.
Line 4.
Line 5.
ACTION NUMBER CALCULATION
Total minuses this period-Part A .' ...........
Cumulative minuses from previous periods in this cycle.
Total minuses (add lines 1 & 2) ..... ........
Action~ number for this period (from table above) . /
Is line 3 greater than line 47 ~]Yes
I_~_f yes, you have a reportable loss and must begin
notification and investigation procedures as described ~;/¢~
tn Kern County Health Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING"
E:nv. Health 580 4113 1016 (6/86)
//7
KERN COUNTY
TREND ANALYS I ~
INSTRUCTION'S:
pART A : OVERAGE/SHORTAGE Fill in all information at top o
form. In the space for yea~~
1 16 period indicate the year and th
DAy DATE i+/T) consecutive period of analysi~
DAY..1 /-~7-5~ ---' being conducted (from I throug],
, DAy 2 /~-~2~ ,~ 12 only). Transfer the date
DAY 3 /o~,~-~7.. '"'-' the sign from columns 1 and 16
=:iDlY 5 at left. Use the table below
'DAY 6 Z-Y- ~ ~ 7~' determine the action number fo]
: DAY ? ~'~' ~ ~ Ill the period being analyzed.
DAY9 ~-{l~I { '' ..... ACTION NUMBER
.DAY 22 ~-~-~ ~ 30-DAY { ACTION
DAY ~Z Z~6-7~ ~ ~ =
DAY 22 ~Y2-?~ ~ , 9 = 149 l
DAY 23 ~-/~ ~ ~ 10 = 165 I
DAY,2? ~-~~ ~ Ctrcte app~opr~a[e period and
DAY ~8 ~-~~ ~ action number. A f~[[ cycle
DAY 29 ~-~~ ,,, ~ made up o~ per~ods 1-~2.
DAY 30 ~-~ ~'-~ ~ ~h~ch a ne~ cycle beE~ns. Use
TO,Ab M[~USES /~ ''~ tnforma[ton [o coa~te[e Pa~ B.
PART B: ACTION NUMBER CALCULATION
Line 1. Total minuses this period-Part A ............
Line 2. Cumulative minuses from previous periods in this cycle..
Line 3. Total minuses (add lines 1 & 2) .............
Line 4. Action number for this period (from table above) . /
Line 5. Is line 3 greater than line 47 ~]Yes
I_~_f .Y.e.s, you have a reportable loss and must begin
notification and investigation procedures as described
in Kern County Health Department HANDBOOK ~UT-IO
"STANDARD INVENTORY CONTROL MONITORING".
inv. H~lth 580 4113 1010
KERN ~'OUNTY H~A~-l'n
TREND ANALYSI ~
TANK # [ CAPACITY /qtc~O? P~RODUCT ~. ce.,~c~ YEAR/PERIOD
I NS'TRUCTION'S :
PART A : OVERAGE/SHORTAGE Fill in all information at top o:
form. In the space for year,
1 16 period indicate the year and th~
.DAY DATE (+/-) consecutive period of analysii
qAY 1 ~.~.~Z.- ~ .... being conducted (from 1 throug{
..~Y 2 2.2~.~z-- ~ 12 only). Transfer the date an~
DAY 3 2'~~-- -~ the sign from columns 1 and 16 o{
DAY 4 ~-~-q~- ~ Reconciliation Sheet to column~
D,,AY 5 ~-'/~' ~ ~ 'l "~ at left. Use the table below t~
DAY 6.,, .~'-~- ~, ~ determine the action number fo~
DAY 7 ~-~-~ ~ the period being analyzed.
D, AY, 9 ~-~- ~ ~. ~ ACTI ON NUMBER
DAY 12 ~-~ ~ -~ ,, , 30-DAY { ACTION
..DAY 14 ~'/~,-~ -- 1 = 20
..... DAY 18 ~/~:?~ ~ , 5 = 05
DAY 24 ~-~ 0 '9'? + 11 = 180
DAY 25 f-Z/-5~ .. . 12 = 196
DAY 27 7-2J- fi~ ~ Circle appropriate period and
DAY 28 ,~ 2~-~ .~ action number. A full cycle Is
DAY 29 ~ ~ ~ made up of periods 1-12, af.ter
..DAY 30 .~-~-?~ ~ which a new cycle begins. Use
TOTAL MINUSES ]~ .{ information to complete Part B.
PART B: ACTION NUMBER CALCULATION
Line 1. Total minuses this period-Part A ............
Line 2. Cumulative minuses from previous periods in this cycle,
Line 3. Total minuses (add lines I & 2) .............
Line 4. Action-number for this period (from table above) . ,. , .//
Line 5. Is line 3 greater than line 4? ~]Yes
If Yes, you have a reportable loss and must begin
notification and investigation procedures as described
in Kern County Health Department HANDBOOK #UT-lO
"STANDARD INVENTORY CONTROL MONITORIN6"
Env. H~lth 580 4113 1016 (6~6)
/'4*?
KERN ~OUNTY fl~A~'l'~ u~rA~'I'MBN'~
TREND ANALYS1 u wu~uflu~'l
TANK # / CAPACITY' /0, 0{20 PRODUCT U,-(,'o:~t''d YEAR/PERIOD
' ' X NSTRUCT['ON'S :
PART A : OVERAGE/SHORTAGE ~ill in all information at top o
form. In the space for year,
1 .lB ,. period indicate the year and th,
DAY DATE .{+/-) consecutive period of analyst:
DAY 1 .7-~'~-~ ~._ ---- being conducted (from 1 throug
DAY 2 ~:.~-~ 7,- ~ rr~d ~~ ~.~,A'~j 12 only). Transfer the date
,DAY 3 J-~/~-~ ,,. " the sign from columns 1 and 16 o
DAY 4 ~-~,~ '~'~"' ~ Reconciliation Sheet to column
DAY 5 ~-~/-,~ at left. Use the table below t
DAY 6 ~-/~ determine the action number fo:
BAY 7 ~-~-~ ~ the period being analyzed.
,DAY 9 ~-~-~,~,~ ACTI ON NUMBER
DAY 10~;g~-~J~ ~ TABLE
DAY 11 ~.~
D~Y 12 ~-:~ ~ 30-DAY I ACTION
DAY 13 - -~ ~ ~ PERIOD ,NUMBER NUMBER
DAY ~5 ~-/O-~z 2 = 3v
DAY !6 ~)')Y' ~ ~ ~ 3 = 54
DAY 27 ~'22~ ~' ' Circle appropriate period and
DAY ~8 ~'~~ ~ action number. A full c~cle
.DAY 29 .~'2.~-~ ~ aade up of periods 1-12, af.ter
.DAY 30 ~~ ' ' ~"' which a new cFcle begins. Use
..TOTAL. NINUSES information to co~plete Part B.
PART B: ACTION NUMBER CALCULATION
Line 1. Total minuses this
Line 2. Cumulative minuses
Line 3. Total minuses (add
Line 4. Action,s'number for
Line 5. Is line 3 greater
If Yes, you have
Env. Health 580 4113 1016
period-Part A ..............
from previous periods in this cycle.
lines 1 & 2) .............
/
this period (from table above) . /
than line 4? ~]Yes
~ reportable loss and must begin
notification and investigation, procedures as described
in Kern County Health Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING?.
'T
TANK ~ / CAPACITY ~ O~ O o O . PRODUCT ~ m Le~ J,~ YEAR/P~RIOD ~/- I/
I NSTRUCTI ON'$ :
PART A : QV.EgAGE[SHORTAGE Fill ia all information at top. o
form. In the space for year,
1 16 period indicate the year and th~
DAY DATE (+/-) consecutive period of analysi~
DAY 1 ~'~G~ ~ being conducted (fro~ 1 throug[
DAY 2 ~(~_~L ~ 12 on.l~). Transfer the date an(
DAY 3 ~-~-'~ ~ the slgQ from columns 1 and 16 o
DAY 4 ~/-~ ~-~ ~ Reconciliation Sheet to column~
DAY 5 ~-~ ~ at left. Use the table belo~
DAY 6 ~/- ~ ~ determine the action number for
DAY ~ ~-~-~ .. ~ the period being analyzed.
.. DAY 8 ~-~ 9 ~ ~ ..,
DAY 9 ~-~-~ ~ ~ ACTI ON NUMBER
DAY 10 ~- ~~ ~ TABLE
DAY 12 f-7- ~ ~ 30-DAY [ ACTION
UAY ~3 ~-~'-~, , mPER[OD NUMBERI NUMBER
, {
DAY 15 ~-/O-9~ ~ 2 =
DAY 22 ~'/7'~ ~ 9 = 149
DAY 23 ;- YFT~ ~ 10 = 165 ,
..,DAY 27 ~-~ -9~ i . Circle appropriate period aud
DA~ 28 f.Z~-9¢ '~ action number. A full cycle
.,~AY 29 ~~-9~ ~ made up of periods 1-12, af.ter
DAY SO f~-$-~]~ which a new cycle begins. Use
TOTAL MINUSES ~ i,nformation to complete Part B.
PART B:' ACTION NUMBER CALCULATION
Line 1. Total minuses this period-Part A ............
Line 2. Cumulative minuses from previous periods in this cycle.
Line $. Total minuses (add lines 1 & 2) .............
Line 4. Action number for this period (from table above) ....
Line 5. Is line 3 greater than line 4? [~Yes ~o
If Yes, you have a reportable loss and must begin
notification and investigation procedures as described
in Kern County Health Department HANDBOOK ~UT-10
"STANDARD INVENTORY CONTROL MONITORING"
Env. H~lth 580 4113 1016 (6/86)
't> '-- t
__~._..--~
DEPARTMENT
TANK it / CAPACITY / O~, 000 ~/ PRODUCT U~'/-¢-,~ · ~ YEAR/PERIOD
I NSTRUCTI ON'S :
PART /k : OVERAGE/SHORTAGE Fill in all information at top of
form. In the space for year/
I 16 period indicate the year and the
DAY DATE ,' (+/-) consecutive period of analysis
DAY 1 ~.~i-~{. '~- being conducted (from 1 through
DAY 2 .C-27-~-- ---- 12 onl,y). Transfer the date and
DAY 3 ~-2~-~ ~ the sign from columns 1 and 16 of
DAY 4 ~':~5-?~ ~ Reconciliation Sheet to columns
DAY 5 ~-ffO-~ ~ at left. Use the table below tc
DAY 6 f-J~-~ ~ determine the action number for
DAY 7 ~-/~~ ~ the period being analyzed.
DAY 8
DAY 9 f-J-O~ ~ ACTI ON NUMBER
DAY 10 ~' ~- ~ ~ TABLE
DAY lZ ~- (-~ ~ ~ 30-DAY I ACTION
DAY 13 ~-7- ~ ~ ~ PERIOD NUMBER[ NUMBER
DAY 14 ~ ~' ~ ~ ~1 = 20
DAY 15 ~-'~~ - ~ 2 ~ 37
DAY 16 ~-/~ - ~ ~ ~ ~ , 3 = 54
DAY 17 ~-//~ ~, ~ 4 = 69
DAY 19 ~-/~- ~ ~ ~ 6 =. 101
DAY 20 ~/~- ~; ~ 7 = 117
DAY 21 ~--/~ ~ ~~ 8 = 133
DAY 22 ~/~ ~ " 9 = 149
DAY 23 ~/~ ~ ~' ~ 10 = 165
DAY 24 ~/~ ~ ~ 11 = 180
DAY 26
_.DAY 27 ~'~/- ~ ~ Circle appropriate period and
DAY 28
DAY 29 ~-~- ~ ~ made up of periods 1-12, after
DAY 30 ~-~-~ ~ which a new cycle begins. Use
TOTAL MINUSES [~ information to complete Part B.
PART B:
Line 1.
Line 2.
Line 3.
Line 4.
Line 5.
ACTION NUMBER CALCULATION
Total minuses this pe?iod-Part A ............
Cumulative minuses from previous periods in this cycle.
Total minuses (add lines 1 & 2) .............
Actto.[} number.:,~;or this period (from table above) . .//
Is line 3 greater than line 47 [-]Yes
If Yes~ you have a reportable loss and must be~in /v~',~ d
notification and investigation procedures as described
p
in Kern County Environmental Health Services Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING".
/5
Env. Healtrt 580 4113 012 (Rev. 6/90)
I
A~NNUAL
TANK
QUARTER 1
PERIOD !:
PERIOD 2:
PERIOD 3:
TREND A~N~LYS I S
TIME PERIOD: /
To~a~ ~nuses Thfs Per~od (~ne 3)
Ac~on Nu=ber for ~h~s Per~od (L~ne 4)
To~a~ ~Inuses Th~s Per~od (~ne 3)
Action ~u~ber for ~h~s Per~od (~ne 4)
To~a~ ~lnuses This Per~od (~ne 3)
Action N~ber for th~s Per~od (L~ne 4)
S UI~F.~RY
QUARTER 2
PERIOD 4:
PERIOD 5:
PERIOD 6:
TIME PERIOD: to
Total Minuses This Period (Line 3)
Action Nuiber for this Period (Line 4)
Total Minuses This Period (Line 3)
Action Nuaber for this Period (Line 4)
Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
QUARTER 3
PERIOD 7:
PERIOD 8:
PERIOD 9:
TINE PERIOD: '~/~-~/¥/ tO
Total Minuses This Period (Line 3)
Action Nulber for this Period (Line 4)
Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
Total Minuses, This Period (Line 3)
Action Number for this Period (Line 4)
QUARTER 4 TINE PERIOD:
PERIOD 10: Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
PERIOD 11: Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
PERIOD 12: Total Minuses This Period (Line 3)
Action Number for this Period (Line 4)
st~natureZ hereby cer~~ie,~/~is a true and accurate report.
HIND~,.iiA;'.:: L~upv Mech i;
Jild
' ~e~eral O~ce~ · Garage Oivis~n"
Date
KERN COUNTY tt ~ A k, ~i' Ii ~ ~- ~ A J~'t' ME t~ ~t~
TREND ANALYS I ~ w t~ tt 1~ ~ ti *'- t~ '1~
~'ACI LI TY ~'OL~'~"']")/ ~-J" ~'e{,'~ [~',~ '{" -f")" PERMI T # I.~ 001'1
· TANK # .-~ CAPACITY-- ~; O (~ ~ ~PRODUCT p; *itt~ YEAR/PERIOD
I NSTRUCTI ON-S :
PART A : OVERAOB/SHORTAGE Fill in all information at top o{
form. In the space for yeart
1 16 period indicate the year and th(
DAY DATE (+/-) consecutive period of analysi~
DAY I 7-/- ~)! ~- ......... being conducted (from I througl
DAY 2 7~,~-'~ - : 12 only). Transfer the date an~
DAY 3 ~,~-~ ~ ~ the sign from columns 1 and 16 o{
..... DAY 4. 7-~'~] ~ Reconciliation Sheet to column~
DAY 5 ~-~-~} ~ at left. Use the table below t~
DAY 6 ~-~-~ ~ ~ determine the action number fox
DAY 7 ~-~-~} ~. . the period betnz analyzed.
DAY 9 y-~-~ -- ACTI ON NUMBER
DAY 10 7-]~'...~/ ~ TABLE
DAY 12 ~/~-~{ , ~ 30'-D~Y { ACTION
'"DAY 13
,
oar
DAY 27 -~~/ ~ Circle appropriate period and
DAY 28
DAY 29 ~-~-~/ ~ made up of periods 1-12, after
DAY 30 ~-~~ ~ which a new cycle begins. Use
TOTAL MINUSES information to complete Part B.
PART B: ACTION NUMBER CALCULATION
Line
Line
Line
Line
Line
1. Total minuses this period-Part A ............
2. Cumulative minuses from previops periods in this cycle.
3. Total minuses (add lines 1 & 2) .............
4. Actiofi~ number for this period (from table above)
5. Is line 3 greater than line 4? ~Yes
If Yes, you have a reportable loss and must begin
notification and investigation, procedures as'described
in Kern County Health Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING" ~ ~"3'-~
17
Env. Healtlm 580 4113 1016 (6/86) ~
KERN
COUNTY
TREND ANALYSI ~ Wu~~'l"
.TANK # ~ CAPACIT~ 2~ O O O --PRODUCT p jeZ~ YEAR/PERIOD
I NSTRUCTI ON'S :
PART A : OVERAGE/SHORTAGE Fill In all information at top
form. In the space for year~
1 !6 period Indicate the year and th~
DAY DATE (+/-) consecutive period of analysil
DAY I ?'-~/~ ( ~ being conducted (from I througl
~AY 2 ~-/-~,] ~- .... 12 only). Transfer the date an~
DAY 3 ~-~.-~{ ~- the sign from columns 1 and 16 Gl
DAY 4 ~ ~] ,,, ~ Reconciliation Sheet to columnl
DAY 5
OAY,,, 6 ~- ~ ~{~ determine th~ action number roi
DAY 7 ~-. ~[ ~ the period being* analyzed.
DAY 9~ f~'l -- ACTI ON NUMBER
DAY 10 ~-~- ~] ~ TABLE
DAY 11 .
DAY 12 ~-//- ~] -- 30-DAY { ACTION
DAY 13 ~'/~-~1 ~ " PERIOD NUMBER~ NUMBER
DAY 14.
DAY 16 ~'/~"' ~t ~ 3 = 54
DAY 17 p'/~'~ ~ [ 4 = 69
DAY 18 ~/~-~/ ... -t [ 5 = 85
DAY 21 ~-'~ ~-~] ~ 8 = 133
DAY 22 ~'~'~l ~ 9 = 149
~AY 23, ~-~'~) ~ 10 = 165
DAY 24 , =
DAY 25 ~-~/ ~ 12 = 196
. DAY 26
DAY 2?. ~ ~/ Circle appropriate period and
DAY 28 ~-~/ .... ~ action number. A full cycle ts
DAY 29 ~2 ~/ - " ~ade up of periods 1-1.2, after
DAY 30 ~-~.~9/ ....... ~ which a new cycle begins. Use
TOTAL MINUSES /.~ informat.~on to cosplete Part B.
PART B: ACTION NUMBER CALCULATION
Line 1. Total minuses this period-Part A ............
Line 2. Cumulative minuses.from previous periods in this cycle.
Line 3. Total minuses (add lines 1 & 2) ' · ........
Line 4.
Line 5.
Actton'~number for this period (from table above) . . . ..// ~,~
Is line 3 greater than line.4? [~Yes
If Yes, you have ~ reportable loss and must begin '/~,$fe~ ~7.'c~
notification and investigation.procedures as described ~d~j -)--~
in Kern County Health Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING". '~-/-~
Env. Health 580 4113 1016 (6/86)
KERN ~OU
TREND
TANK # ,.~ cAPACITY ~, OOO PRODUCT Di ¢~ret~ YEAR/PERIOD
INSTRUCTION'S:
PART A : OVERAGE/SHORTAGE Fill in all information at top o:
~ form. In the space for yea~,
i 16 period indicate the year and th~
DA~ DATE .... (+/-) consecutive period of analysl~
DAY i ~0-~], -it-., being conducted (from I throng{
DAY 2. ~! -~/. -~- .. 12 only). Transfer the date an~
DAY
DAY 4 ~Z-~ ) ~- , Reconciliation Sheet to column~
DAY 5 ~-~-5/ ~ at left. Use the table below t,
DAY 6 ~-~9! --~ determine the action number fo]
DAY 7, ~-~-~1 ....... ~., the period being analyzed'.
DAY 8 ?,~-~ { ~ .....
DAY 9 ~-7-~l --, ACTI ON NUMBER
DAY 10 . ~-~"ql TABLE
DAY 12 ~-/O-~} , , -~' 30-DAY { ACTION
DAY,ia 5-//-0l ~ PERIOD NUMBER{ NUMBER
DAY 17
DAY 22 ~0-~ ~ 9 = 149
DAy ,24 ~-~Z-O/~ 11 = 180
DAY 2~ 9-2Y-q/ -- Circle appropriate period and
DAY 28
DAY 29 ~?~-~[ ~ made up of periods 1-12, af.ter
~AY 30 ~-~-~{ .. -~ .:' which a new cycle beitns. Use
.,TOTAL MINUSES, ..... , /,[ information to complete Part B.
PART ~: ACTION NUMBER CALCULATION
Line 1. Total minuses this period-Part A
Line 2. Cumulative minuses from previous
Line 3. Total minuses (add lines I & 2)
Line 4. Action number for this
Line 5. Is line 3 greater than
If Yes, you have ~
periods in this cycle.
period (from table above) ....
line 4? ~]Yes [~o
~.eportable loss and~ must begin
as described
#UT-lO
notification and investigation procedures
in Kern County Health Department HANDBOOK
"STANDARD INVENTORY CONTROL MONITORING".
Env. H~Jth 580 ills 1016 (6/86)
P
COUNTY
TREND ANALYSI ~ Wu~~'l
~'AC ILI TY C OU~"]-y O t /~cr~-- //~ O" f'7:' PERMI T #
TANK # ~ CAPACITY/ 7. t9 0 0 ~RODUCT t) i ef~C YEAR/PERIOD
.. I NSTRUCTI ON'S :
PART A : OVERAGE/SHORTAGE Fill in all information at top o:
form. In the space for year,
1" 16 period indicate the year and th~
DAY DATE (+/-) consecutive period of analysi,~
DAY I ~"~'~l ~ being conducted (from I throng]
DAY 2 ~o(~ ~-' 12 onlY). Transfer the date an,
DAY 3 / ~ ,,, the sign from columns i and 16
DAY,4 / ~)~ 2-- ~)/ ~ Reconciliation Sheet to column{
DAY,5 /~'_~t , , ~ at left. Use the table below t~
DAY 6 I~-q'~l { ~ determine the action number fo]
DAY 7 /d-~/ ~/ the period being analyzed.
DAY 9 /~'~,~1 ~ ACTX ON NUMBER
DAY 10 /~-~-'~] ~ .. TABLE
DAY ,1R /~-/0-~( ~ { 30-DAY ] ACTION
DAY 13 /O-//--~l -- I PERIOD NUMBER[ NUMBER
DAY 16 ID~/~/~l .....~ i 3 = 54
DAY 1~ /~ ~/~-~/ ~ ~ =
DAY 18 ~-/~' ~/ ~ 5 = 85
DAY 19 '/~/~?~, ~ 6 = 101
DAY 21 /~-/~J ~ 8 = 133
DAY 22 /~-~/ ~ 9 = 149
DAY 23 /d~/-~/ ~ 10 = 165
DAY =
DAY 25 /~ ~]- ~,~ 12 = 196
DAY 26 /0~2~'~1
,,,DAY 2~ /0-2 ~-9/ - Circle appropriate period and
DAY 28 /0-~{, ~ action number. A full cycle
DAY 29 /~-~7-~ ~ made up of periods 1-12, af.ter
,DAY 30 /~,'~/ ~ which a new cycle bezins. Use
TOTAL MINUS,ES {~ tnformati, on to complete Part B.
PART B: ACTION NUMBER CALCULATION
Line 1. Total minuses this period-Part A ............
Line 2. Cumulative minuses from previous periods in this cycle.
Line 3. Total minuses (add lines I & 2) .............
Line 4. Action number for this period (from table above) ....
Line 5. Is line 3 greater than line 4? ~]Yes ~No
If Yes, you have a reportable loss and must begin
notification and investigation procedures as described
in Kern County Health Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING"
inv. H~lth 580 4113 1016 (6/86)
KERN COUNTY
TREND ANALYS I ~ w o ~t 1~ ~ tt ~- l~ 'l
~'ACILITY COt/n~--~ O~ era ' ~3 ~ 3~ PERMIT ~liOo /c
TANK $ ' ~ CAPACITY/ ~ 0o0 PRODUCT ~i'e~tc YEAR/PSRIO~ ~
~ ' I NSTRUCTI'ON'S :
PART A : 0VE~%~E/SHORTAGE Fill In all information at top o]
form. In the space for
1 16 period indicate the year and
DAY DATE (+/-) consecutive period of.
DAY 1 /~-~9~ ~ being conducted . (fro. 1 throuzI
DAY 2 '/~'~d'9] --- 12 only). Transfer the dmte
DAY 3 /~'//,~-} ~ the sign from columns 1 and 16 el
DAV 4 {{-{-~ '~ Recon~iliation Sheet to ~olumnl
DAY 5 ~ ]~
at left. Use the table below
DAY 6 )Y-~-'9] { ..... determine the a~tion number fo~
DAY 7 j/~-.9~y -- the period being analyzed.
OAY 8 g- ~-~ t ..... ~ ......
OAr 9 //-&-~l + ACTION NU~ER~
DAY ~2 /~- ~--9~ ~ 30-DAY { ACTION
DAY 18 //-/~'~,~ ~ PERIOD NUMBER{ NUMBER
DAY 16 .)y-/3-%i , , , -- 3 = 54
DAY 18 //-~ ~-91 ~ 5 = 8U
DAY 22 //--J~--~/ -- 9 = 149
DAY ag t/-~-~I ~ Clecle appropriate period and
DAY 28 //-~-~/ / action number. A full cycle Is
DAY 29 //-~i-41 ,,~ made u~ of periods 1-12, af.ter
DAY 30 //-~-~ which a new cycle begins. Use
TOTAL MINUSES ]{ information to ~omple~e Part B.
PART B: ACTION NUMBER.'CALCULATION
Line 1. Total minuses this period-Part A ............
Line 2. Cumulative minuses from previous periods in this cycle.
Line 3. Total minuses (add lines I & 2) .............
Line 4. Actto~ number for this period (from table above) ....
Line 5. Is line 3 greater than line 4? [-]Yes 0o
If Yes, you have a reportable loss and must begin
notification and investigation procedures as described
in Kern County Health Department HANDBOOK #UT-lO
"STANDARD INVENTORY CONTROL MONITORING"
Env. Health 580 4113 1016 (6/86)
KERN COUNTY
TREND ANALYSX ~
TANK # CAPACITY-- ~, Q t9 o RODUCT ~l'df.eL YEAR/PERIOD
I NSTRUCTI ON'S :
PART A :' OVERAGE/SHORTAGE Fill in all information at top o:
form. In the space for year,
1 16 period indicate the year and th~
DAY DATE (+/-) consecutive period of analysl~
DAY.,,1.,, [{~-~'i ---' being conducted (from 1 throng{
DAY 2 !_{-~-~} ~- , 12 only). Transfer the date an~
DAY 3 ~lo~0-~{ --- the sign from columns 1 and 16 o:
DAY ,4 })- }'- ~ { ~ ; Reconciliation Sheet to column~
DAY 5 l~-~'5~ ..- at left. Use the table below t~
DAY 6 . [~-JT~ ~ determine the action number fol
DAY 7 I~-~-~{ ~ the period being analyzed.
DAY 9 12-~-51. ~. ACTI ON NUMBER
DAY 10 /~- 7-51 -- TABLE
DAY 22 ~ - ~--~/ ~ ' ' 30-DAY { ACTION
DAY 1~ /~/~-~1 ~, , , PERIOD NUMBERI NUMBER
DAY 16 /~- IJ-~l ~ 3 = 54
DAY 18 /27YF-qI ,~ . 5 = 85
DAY 27 '[~-2~-~/ ~ Circle appropriate period and
DAY 28 /~ff--S] ~ action number. A full cycle is
, .DAY 29 /2~2~/ ~ made up of periods 1-12, af.ter
DAY 30 /~27-~/ ~ which a new cycle begins. Use
TOTAL MINUSES /~ .. Information to cosplete Part B.
PART B: ACTION NUMBER CALCULATION
Line 1. Total minuses this period-Part A ............
Line 2. Cumulative minuses from previous periods in this cycle.
Line 3. Total minuses (add lines 1 & 2) .............
Line 4. Acttoff number for this period (from table above)
Line 5. Is line 3 greater than line 4? r~yes
I_~f Yes, you have ~ reportable loss and must begin
notification and investigation procedures as described
in Kern County Health Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING". p
Env. H~lth 580 4113 1016 (6/86)
7
KERN COUNTY
TREND ANALYS1 ~ wut~t~.att*--ll'l
~'AC I L'I TY C'OU~fy O~ K~r~ I'1~ 0" 37-.' PERMIT #J.,~O011
TANK # ~ CAPACITY fY_/ ~'O c~ FRODUCT p1'¢$,/- YEAR/PERIOD
I NSTRUCTI ON'S :
PART A : OVERAGE/SHORT4GE 'Fill In all Information at top o!
form. In the space for year/
1 16 period indicate the year and the
DAY DATE (+/L) consecutive period of analysis
,D,.AY 1 /2.~.~.~m[' .,L.{.--' being conducted (from 1 throug!
DAY 2 1~'~-~1" , ,,~' 12 only). Transfer the date an~
DAY 3 /~-~¢-~/ ~ the sign from columns 1 and 16 o{
DAY 4 ,,~2-~1- ~ ~' ~ Reconciliation Sheet to columnl
DAY 5 .'/-~~ ~ at left. Use the table below t~
DAY 6 1-2-~ ,, ~ determine the action number roi
DAY 7 ~ ~ ~ ~ the period betn~ analyzed.
DAY 9 /- ~-,~ ..... ~ .... ACTX ON NUMBER
DAY 10 /-~~ . . TABLE
DAY 12 /-~-~ ~ ~ 30-DAY { ACTION
DAY 1~ /- ~-'~ ~ PERIOD NUMBER~ NUMBER
DAY 19 / ~/~-- ~ ~ ~ 6 = 101
,,DAY 77 /-Z~>'~Z ~ Circle appropriate period and
.DAY 28 1-~-~ ~ action number. A full cycle is
.,,OAY 29 /~,~-e~ ~ made up of periods 1-12, al.rev
DAY 30 /-2~-,~ ~ which a new cycle begins. Use'
TOTAL MINUSES ]~ info~mation tq, complete Part B.
PART B:
Line 1.
Line 2J
Line 3.
Line 4.
Line 5.
ACTION NUMBER
Total minuses this
Cumulative minuses
Total minuses (add
CALCULATION
Action; number
Is.line 3 greater than
I_~f yes, you have a
period-Part A ............
from previous periods in this Cycle.
lines 1 & 2) ............. /, /
for this period (from table above) . . . /
line 47 ~]Yes ~]No
~eportable loss and must begin
notification and investigation procedures as described
tn Kern County Health Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING"
Env. Health 580 4113 1016 (6/86)
//
?¥
TREND ANALYSIs
TANK ~ . ,J, CAPACITY/ ~/ O0 0 ~RODUCT _ ~, eat6 YEAR/PERIOD
, , ][ NSTRUCTi""ON-$ :
PART A : OVERAGE/SHORTAGE Fill in all information at top. o,1
form. In the space for year~
1 16 period indicate the year and tht
DAy DATE ~+/-) consecutive period of analyst~
DAY.1 /~7-°/z-' ~ being conducted (fro~ I throu~l
DAY ,2 /'2~5..~ ~ 12 0nly). Transfer the date an~
..DAY 3 /-Z~-~ ~ the si~n from columns 1 and 16 el
DAY 4 ;_/'~-~ '' .~ Reconciliation Sheet to column~
DAY 5 /;~l-~ ~ at left. Use the table below t~
DAY 6 ~"/-.~ ~ ~' . determine the action number fei
DAY 7 ~-2-~.~ ~ "' . . the period being analyzed.
DAY 9 .~e~' ~ ..... ACTI ON NUMBER
DAY 10 ~ -~-'~ .. ~ TABLE
DAY 12 2- 7- ~ ~ 30-DAy I ACTION
.O,l¥, 1~ ~-F-~; ,,. ~ .... PERIOD NUMBER[ NUMBER
,..DAY 15 ~'-/O-~ '' ' -- 2 = 37 ,
DAY 18 ~-/Y- ?~ ~' { 5 = 85
DAY 21 ~-/~-?~ ~ 8 =
.DAY 22 ~'27:~ ,., ~ 9 = 149
DAY 25 ,.2~2 0-~ '~ - 12 = 196
.DAY 2,7 ~-~'~'~ ~ ~ Circle appropriate period and
.DAY 28 2-Z,~-'.~ ~ action number. A full cycle is
DAY 29 ~-2~-~ - made up of periods 1-12, af.ter
DAY 30 ~-Z~ .~ which a new cycle beEtns, Use
TOTAL MINUSES ~ ~.' information to complete Part B.
PART B:
Line 1. Total minuses this
Line 2. Cumulative minuses
Line 3. Total minuses (add
Line 4. Action number for
Line 5. Is line 3 greater
ACTION NUMBER CALCULATION
period-Part A ............
from previous periods in this cycle.
lines 1 & 2) .............
period (from table above) . , , ./
this
than line 4? OYes ~No
If Yes, you have a reportable loss and must begin
notification and investigation procedures as described
in Kern County Health Department HANDBOOK #UT-10 ~¢.~'~
"STANDARD INVENTORY CONTROL ~ONITORING"
Env. H.Ith 580 4113 1016 (6186)
KERN COUNTY
TREND ANALYSI ~
I NSTRUCTI ON:S :
PART & : QVERAGEISHORTAGE Fill tn all Information at top Gl
form. In the space for yea-r ~
1 16 period indicate the year and th~
'~AY DATE '" (+/-) consecutive period of analysit
DAY 1 ~-~-')~'- ' "~" ' ... being con'ducted (from 1 throug{
DAY 2 ~-~7-~ ~ ~ 12 only). Transfer the date an(
DAY 3 2-~-~ ~ the sign from columns 1 and 16 oJ
DAY 4 ~-~'9'~~ ~ Reconciliation Sheet to column~
DAY 5,, ~[-~- ~ at left. Use the table below t~
DAY 6 ~- ~- ~ ~.. ~ determine the action number fol
,DAY 7 ~-~-.~. ~ ., , the period being analyzed.
.,,OlY 9 3,-~-~ - " ACTX ON NUMBER
· DAY 12 ~.-~- ~ ~ ,, , 30-DAY [ ACTION
DAy 13 ,~-~--~ ~ PERIOD NUMBERI NUMBER
DAY 14 ~-YO- ~ ~ 1 = 20
DAY 2~ ,,f-~~ ~ Circle appropriate period and
DAy 28 3-a~-~Z~.,. action number. A full cycle is
DAY 29 ~-2f-,q~ ~ made up of periods 1-12, af.ter
,,,DAy 30 ff-~-~ .~ which a new cycle begins. Use
,TOTAL MINUSgS /~ information to complete Part B.
PART B: ACTION NUMBER CALCULATION
Line 1. Total minuses this period-Part A ............
Line 2. Cumulative minuses from previous periods in this cycle.
Line 3. Total minuses (add lines 1 & 2) '
Line 4. Action number for this period (from table above) . /
Line 5. Is line 3 greater than line 4? ~]Yes
I_~f Yes-, YOU have a reportable loss and must begin
notification and investigation procedures as described
In Kern County Health'0epartment HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING"
inv. I-4~atth 580 4113 ~0~6
/o7
KERN COUNTY
TREND ANALYS1 ~
TANK # ~ CAPACITY '~ '2/ o o o PRODUCT 'i~i c J,',t YEAR/PERIOD
I NsTRUCTI.,ON'$ :
PART A : OVERAGE/SHORTAGE Fill in all information at top Gl
form. In the space for year',
1 16 . period indicate the year and th~
DAY DATE. .... (+J-) consecutive period of analysii
DAY 1 ~7-27772._ ~ being conducted (from 1' throng{
DAY 2 .7'-2P-°/-L~ A,~,'j',r~.J ~,~-~-e~,, ~.~J,'~. 12 only). Transfer the date an(
DAY 3 f-2~-~Z~ ~ " the sign from columns 1 and 16 ol
DAY 4 ;7-.7 0' ~) z-~ ~'
:~- Reconciliation Sheet to column~
DAY 5' ~-fl-~ at left. Use the table below t~
pAY 6' ~-/-~ ~ .... determine the action number roi
DAY q ~-~-~ ~ the period being analyzed.
DAY, ~ .... ~'~- ~ ~
DAY 9 ~- ~-?~ ' ~ , , ACTI ON NUMBER
DAY 10 ~'J- 5v ~ TABLE
DAY 11 ~-~-'.~ . ~
pAY 13 '1 ~ }PERIOD NUMBERI NUMBER
DAY lT ~-/~'~ , ,, ~ 4 = 69
DAY 19 ~-/~- ~ ..... , ...... i 6 = 101
DAY 20 ~/~-.~ ~ ~ 7 = 117
.... p,~Y 2,~ ~-/~-~"~ 8 =
DAY 22 - ~-/7- ~ ,,~ 9 = 149
DAY ~ ~/y-~ ~ ,~. ~ 16~
DAY.24 ~/~V~ ~ l~ = ~80
DAY 25 ~/~ ~ - ~ -- 12 ~ 196
DAY 2~ ~~ ~ 6ircle appropriate period and
DAY 28 ~~' ~ action number. A full cycle
DAY 29 ~-~~ ~ .... made up of periods 1-12, af.ter
DAY 30 ~~ ~ which, a new cycle begins. Use
TOTAL MINUSES information to complete Part B.
PART B: ACTION .NUMBER CALCULATION
Line
Line
Line
Line
Line
1. Total minuses this period-Part A ............
2. Cumulative minuses from previous periods in this cycle.
3. Total minuses (add lines I & 2) .............
4. Action'number for this period {from table above)
5. Is line 3 greater than line 4? [~Yes ~No
If Yes, YOu have ~ reportable loss and must begin
notification'and investigation procedures as described fvx'~£/e~
in Kern County Health Department HANDBOOK ~UT-iO
"'STANDARD INVENTORY CONTROL MONITORING". ~ ~-T-¢
Env. Health 580 4113 1016 (6/86)
KERN COUN~
ENVIRONMENTAL HEALTH SER~ES DEPARTMENT
TREND ANALYSIS WORKSHEET
TANK $ -~ CAPACITY-- ~ 0 00 P~0DUCT /)l' ¢f¢~' YEAR/PERIOD c~)-ii
I NSTRUCTI ON'S.:
PART A : OVERAGE/SHORTAGE Fill in all information at top o!
form. In the space for year/
1 16 period indicate the year and
DAY DATE (+/-) consecutive period of analysi~
DAY 1 ~2 i-~ ~ '-~ being conducted (from 1 througl
DAY 2 ~7-~ ------ 12 only). Transfer the date an(
DAY 3 ~,x~ -]-- the sign from columns 1 and 16 o!
DAY 4 ~.Z ~. ~ ~ Reconciliation Sheet to columnt
DAY 5 ~-~o-~-~- ~-- at left. Use the table below
DAy 6 ,~-/~ ~-- ---- determine the action number fo~
DAY 7 ~-2- ~ -~ the period being analyzed.
DAY 9 f.~ ~ ~ ACTI ON NUMBER
DAY 10 y-~-~ -- TABLE
DAY 12 ~.~_ ~ _ 30-DAY { ACTION
DAY 13 ~-~ ~ ~ PERIOD NUMBER{ NUMBER
DAY 14 ~-~-~ ~ t = 20
DAY 15 ~-/0-~-. ~ ' 2 =
DAY 16 ~-~-~ ~ 3 = 54
DAY 17 ~-/2-'~ - ~ 4 = 69
DAY 18 ~-lJ-~- ~ 5 = 85
DAY 20 ~--/5- ~ ~ ~ 7 = 117
uny at ,,, · 8 = t33
DAY 22 ~_/~.9~., ~ 9 = 149
uny 23 lo =
DAY 24 ~/~-~ ~ 11 = 180
DAY 26 ~-~/- 9.~
DAY 27 ~,y~-~ ~ Circle appropriate period and
DAY 28 ~.2y-q~ ~ action number, A full cycle is
DAY 29 ~-~ ~ made up of periods 1-12, after
DAY 30 ~-9~- ~ which a new cycle begins, Use
TOTAL MINUSES I~ information to complete Part B.
PART B:
Line 1.
Line 2.
Line 3.
Line 4.
Line 5.
ACTION NUMBER CALCULATION
Total minuses this period-Part A ............
Cumulative minuses from previous periods in this cycle.
Total minuses (add lines I & 2) ...............
/
Action number for this period (from table above) , /
Is line 3 greater than line 47 ~]Yes
If Yes~ you have a reportable loss and must besin
notification and investigation procedures as described
~fO
in Kern County Environmental Health Services Department HANDBOOK #UT-10 D~T~ '-----
''STANDARD INVENTORY CONTROL MONITORING".
Env. Health 580 4113 012 (Rev. 6/90)
ENVIRONMENTAL HEALTH sER~ES
TREND ANALYSIS WORKSHEET
DEPARTMENT
ACXLXT¥ oF # /CO b"IC
TANK # ~ CAPACITY -- '~-/ () O ~ ' PRODUCT 'Vi e~¢~, YEAR/PERIOD ~/-
I NSTRUCTI ON'S :
PART A : .OVERAGE/SHORTAGE Fill in all information at top of
form. In the space for year/
1 16 period indicate the year and th~
DAY DATE {+/-) consecutive period of analysis
DAY 1 ~'-2~'~- ~ being conducted (from 1 through
DAY 2 ~,-~,~-~ 12 only). Transfer the date and
DAY 3 ~C'2~-~{.. ~ the sign from columns 1 and 16 of
~DAY 4 ~:~-~ ~ Reconciliation Sheet to columns
DAY ,5 ~-~~ ~ at left. Use the table below tc
,DAY 6 ~f/-~ ~ determine the action number for
DAY 7 ~-/-~ ~ the period being analyzed.
DAY 8 ~'~-~ ,.,' ' -~ ~
,DAY 9 ~-'~' ~v ~ ACTI ON NUMBER'
DAY 10 ~- ~' ~ ~ - TABLE
DAY 11 ~-~-~' ~
,DAY 12 ~-~ ~ ~ 30-DAY ] ACTION
DAY 13 ~ ~ ~ ;PERIOD NUMBER[ NUMBER
, DAY 14 ~.~. ~ _ -' I = 20
DAY 16 ~/d-~ ~ 3 = 54
DAY 18 ~-/y -~ ~ ~ 5 = 85
DAY 19 ~/ F~ -- 6 = 101
DAY 20 ~7~- ~ ~ .... ~ 7 = 117
DAY 21 ~/~ ~ ~~ 8 ~ 133 ,
DAY 22 ~-/g -- 9 ~ ~ 9 = 149
DAY 23 ~-/7 ~ ~ ~ 10 = 165
DAY 24 g~/~ ~ ~ 11 = 180
DAY 26 ~*~ ~ ~ ~ ~ ~
DAY27 ~'~/ -- ~r~'~ Circle appropriate period and
DAY 28 ~-~ ~ action number. A full cycle is
DAY 29 ~~,- ~ made up of periods 1-12, after'
DAY 30 ~-~ ~ which a new cycle begins. Use
TOTAL ~INUSRS ,, information to complete Part B.
PART B:
Line 1.
Line 2.
Line 3.
Line 4.
Line 5.
ACTION NUMBER CALCULATION
Total minuses this period-Part A ............
Cumulative minuses from previous periods in this cycle.
Total minuses (add lines 1 & 2)
Action number for this period (from table above) /~
Is line 3 greater than line 4? ~']Yes
If Yes, you have a reportable loss and must be~in ~"7,
notification and investigation procedures as described -[-~
~¢"i
in Kern County Environmental Health Services Department HANDBOOK #UT-10
"STANDARD INVENTORY CONTROL MONITORING".
Env. Health 580 4113 012 (Rev. 6/90)