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picture1_Printable Inventory Form 43099 | Invctrlform


 256x       Filetype XLS       File size 0.20 MB       Source: files.dep.state.pa.us


File: Printable Inventory Form 43099 | Invctrlform
sheet 1 blank form monthly inventory record developed by pennsylvania department of environmental protection 92002ver facility name facility id tank id number amp type of fuel amp tank size month ...

icon picture XLS Filetype Excel XLS | Posted on 16 Aug 2022 | 3 years ago

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Partial file snippet. 
Sheet 1: Blank Form


	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	

		MONTHLY INVENTORY RECORD
		Developed by Pennsylvania Department of Environmental Protection   9/2002ver
		

		

	

	

		FACILITY NAME:
		

		

		FACILITY ID #:
		

		

		

	

	

		TANK ID NUMBER & TYPE OF FUEL & TANK SIZE:
		

		

		

	

	

		MONTH & YEAR:
		

		

		

	

	

		DATE OF WATER CHECK:
		

		      WATER LEVEL (INCHES):
		

		

		

	

	

		 
		

		

	

	

		Date
		Start Stick Inventory (Gallons)
		Gallons Delivered
		Gallons Pumped
		Book Inventory Gallons
		End Stick/ATG Inventory 
		Daily over (+) or short (-)           ("End" - "Book")
		Initials
		

		

	

	

		(Inches)
		(Gallons)
		

		

	

	

		Previous Month End Stick
		

		

		

		

		

		

		

	

	

		31
		

		(+)
		0
		(-)
		0
		(=)
		X
		

		0
		X
		

		

		

	

	

		1
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		2
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		3
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		4
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		5
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		6
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		7
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		8
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		9
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		10
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		11
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		12
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		13
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		14
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		15
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		16
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		17
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		18
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		19
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		20
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		21
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		22
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		23
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		24
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		25
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		26
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		27
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		28
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		29
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		30
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		0
		#VALUE!
		

		

		

	

	

		

		TOTAL GALLONS DELIVERED
		->
		0
		 
		0
		<-
		TOTAL GALLONS PUMPED
		

		TOTAL GALLONS OVER OR SHORT
		>
		#VALUE!
		 
		

		

	

	

		MATH CHECK
		Start Stick
		 
		/l\
		/l\
		 
		End Stick
		

		/l\
		

		

	

	

		l
		l
		l
		

		                                                                                                                                                                                                                                                                              
	

	

		\l/
		\l/
		\l/
		

		

	

	

		#VALUE!
		+
		0
		-
		0
		=
		#VALUE!
		=
		#VALUE!
		=
		#VALUE!
		-
		#VALUE!
		

		

	

	

		

		

		/l\
		

		

	

	

		l
		TOTAL GALLONS OVER OR <<SHORT
		

		

	

	

		LEAK CHECK
		 TOTAL GALLONS PUMPED X 0.01 = 
		0
		+
		130
		=
		130
		compare to
		\l/
		

		

	

	

		#VALUE!
		

		

	

	

		

		

		

	

	

		Is the "TOTAL GALLONS OVER OR SHORT" LARGER than "LEAK CHECK" result?    
		

		

	

	

		#VALUE!
		

		

	

	

		If answer is "YES" INITIATE A SUSPECTED RELEASE INVESTIGATION as per Chaper 245.304
		

		

	

	

		PRINT AND KEEP THIS PIECE OF PAPER ON FILE FOR AT LEAST 1 YEAR
		

		

	

	

		

		

		

		

		

		

		

		

		

		 
		

		

		

		

		

		

		

		

		

		

	

	

		

		

		

		

		 
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	






Sheet 2: Ex -- Op Days


	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	

		MONTHLY INVENTORY RECORD
		Developed by Pennsylvania Department of Environmental Protection   9/2002ver
		

		

	

	

		FACILITY NAME:
		Walt's Gas & Go-Go
		

		FACILITY ID #:
		99-01234
		

		

	

	

		TANK ID NUMBER & TYPE OF FUEL & TANK SIZE:
		013: 10K, gasoline (premium)
		

		

	

	

		MONTH & YEAR:
		February-02
		

		

	

	

		DATE OF WATER CHECK:
		12/10/2002
		      WATER LEVEL (INCHES):
		< .25
		

		

	

	

		 
		

		

	

	

		Date
		Start Stick Inventory (Gallons)
		Gallons Delivered
		Gallons Pumped
		Book Inventory Gallons
		End Stick/ATG Inventory 
		Daily over (+) or short (-)           ("End" - "Book")
		Initials
		

		

	

	

		(Inches)
		(Gallons)
		

		

	

	

		Previous Month End Stick
		

		

		

		

		

		

		

	

	

		31
		 
		(+)
		0
		(-)
		0
		(=)
		0
		

		

		X
		

		

		

	

	

		1
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		2
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		3
		5512
		(+)
		0
		(-)
		5
		(=)
		5507
		51 3/4
		5512
		5
		

		

		

	

	

		4
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		51 5/8
		5496
		#VALUE!
		

		

		

	

	

		5
		#VALUE!
		(+)
		0
		(-)
		22
		(=)
		#VALUE!
		51 1/2
		5479
		#VALUE!
		

		

		

	

	

		6
		#VALUE!
		(+)
		0
		(-)
		10
		(=)
		#VALUE!
		51 1/2
		5479
		#VALUE!
		

		

		

	

	

		7
		#VALUE!
		(+)
		0
		(-)
		43
		(=)
		#VALUE!
		51 1/8
		5430
		#VALUE!
		

		

		

	

	

		8
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		9
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		10
		#VALUE!
		(+)
		0
		(-)
		25
		(=)
		#VALUE!
		51 -
		5413
		#VALUE!
		

		

		

	

	

		11
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		51 1/8
		5430
		#VALUE!
		

		

		

	

	

		12
		#VALUE!
		(+)
		0
		(-)
		77
		(=)
		#VALUE!
		50 3/8
		5330
		#VALUE!
		

		

		

	

	

		13
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		50 1/4
		5313
		#VALUE!
		

		

		

	

	

		14
		#VALUE!
		(+)
		0
		(-)
		7
		(=)
		#VALUE!
		50 1/4
		5313
		#VALUE!
		

		

		

	

	

		15
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		16
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		17
		#VALUE!
		(+)
		0
		(-)
		142
		(=)
		#VALUE!
		49 1/4
		5180
		#VALUE!
		

		

		

	

	

		18
		#VALUE!
		(+)
		0
		(-)
		33
		(=)
		#VALUE!
		49 -
		5147
		#VALUE!
		

		

		

	

	

		19
		#VALUE!
		(+)
		0
		(-)
		100
		(=)
		#VALUE!
		48 1/4
		5047
		#VALUE!
		

		

		

	

	

		20
		#VALUE!
		(+)
		0
		(-)
		111
		(=)
		#VALUE!
		47 1/2
		4948
		#VALUE!
		

		

		

	

	

		21
		#VALUE!
		(+)
		0
		(-)
		46
		(=)
		#VALUE!
		47 1/8
		4898
		#VALUE!
		

		

		

	

	

		22
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		23
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		24
		#VALUE!
		(+)
		0
		(-)
		13
		(=)
		#VALUE!
		47 -
		4881
		#VALUE!
		

		

		

	

	

		25
		#VALUE!
		(+)
		0
		(-)
		84
		(=)
		#VALUE!
		46 1/2
		4815
		#VALUE!
		

		

		

	

	

		26
		#VALUE!
		(+)
		250
		(-)
		101
		(=)
		#VALUE!
		47 3/4
		4981
		#VALUE!
		

		

		

	

	

		27
		#VALUE!
		(+)
		0
		(-)
		28
		(=)
		#VALUE!
		47 1/4
		4914
		#VALUE!
		

		

		

	

	

		28
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		29
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		30
		#VALUE!
		(+)
		0
		(-)
		0
		(=)
		#VALUE!
		

		

		#VALUE!
		

		

		

	

	

		

		TOTAL GALLONS DELIVERED
		->
		250
		 
		847
		<-
		TOTAL GALLONS PUMPED
		

		TOTAL GALLONS OVER OR SHORT
		>
		#VALUE!
		 
		

		

	

	

		MATH CHECK
		Start Stick
		 
		/l\
		/l\
		 
		End Stick
		

		/l\
		

		

	

	

		l
		l
		l
		

		                                                                                                                                                                                                                                                               
	

	

		\l/
		\l/
		\l/
		

		

	

	

		#VALUE!
		+
		250
		-
		847
		=
		#VALUE!
		=
		#VALUE!
		=
		#VALUE!
		-
		#VALUE!
		

		

	

	

		

		

		/l\
		

		

	

	

		l
		TOTAL GALLONS OVER OR <<SHORT
		

		

	

	

		LEAK CHECK
		 TOTAL GALLONS PUMPED X 0.01 = 
		8
		+
		130
		=
		138
		compare to
		\l/
		

		

	

	

		#VALUE!
		

		

	

	

		

		

		

	

	

		Is the "TOTAL GALLONS OVER OR SHORT" LARGER than "LEAK CHECK" result?    
		

		

	

	

		#VALUE!
		

		

	

	

		If answer is "YES" INITIATE A SUSPECTED RELEASE INVESTIGATION as per Chaper 245.304
		

		

	

	

		PRINT AND KEEP THIS PIECE OF PAPER ON FILE FOR AT LEAST 1 YEAR
		

		

	

	

		

		

		

		

		

		

		

		

		

		 
		

		

		

		

		

		

		

		

		

		

	

	

		

		

		

		

		 
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	






Sheet 3: Ex -- ATG, Failed


	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	

		MONTHLY INVENTORY RECORD
		Developed by Pennsylvania Department of Environmental Protection   8/2002ver
		

		

	

	

		FACILITY NAME:
		ABC SERVICE STATION
		

		FACILITY ID #:
		00-00000
		

		

	

	

		TANK ID NUMBER & TYPE OF FUEL & TANK SIZE:
		001  PREMIUM  10,000
		

		

	

	

		MONTH & YEAR:
		Aug-05
		

		

	

	

		DATE OF WATER CHECK:
		8/1/2005
		      WATER LEVEL (INCHES):
		.50
		

		

	

	

		 
		

		

	

	

		Date
		Start Stick Inventory (Gallons)
		Gallons Delivered
		Gallons Pumped
		Book Inventory Gallons
		End Stick/ATG Inventory 
		Daily over (+) or short (-)           ("End" - "Book")
		Initials
		

		

	

	

		(Inches)
		(Gallons)
		

		

	

	

		Previous Month End Stick
		

		

		

		

		

		

		

	

	

		31
		1653
		(+)
		7300
		(-)
		323
		(=)
		8630
		ATG
		8677
		47
		

		

		

	

	

		1
		8677
		(+)
		0
		(-)
		318
		(=)
		8359
		

		8352
		-7
		

		

		

	

	

		2
		8352
		(+)
		0
		(-)
		405
		(=)
		7947
		

		7946
		-1
		

		

		

	

	

		3
		7946
		(+)
		0
		(-)
		301
		(=)
		7645
		

		7639
		-6
		

		

		

	

	

		4
		7639
		(+)
		0
		(-)
		573
		(=)
		7066
		

		7038
		-28
		

		

		

	

	

		5
		7038
		(+)
		0
		(-)
		649
		(=)
		6389
		

		6380
		-9
		

		

		

	

	

		6
		6380
		(+)
		0
		(-)
		567
		(=)
		5813
		

		5824
		11
		

		

		

	

	

		7
		5824
		(+)
		0
		(-)
		252
		(=)
		5572
		

		5578
		6
		

		

		

	

	

		8
		5578
		(+)
		0
		(-)
		172
		(=)
		5406
		

		5405
		-1
		

		

		

	

	

		9
		5405
		(+)
		0
		(-)
		441
		(=)
		4964
		

		4961
		-3
		

		

		

	

	

		10
		4961
		(+)
		0
		(-)
		1007
		(=)
		3954
		

		4298
		344
		

		

		

	

	

		11
		4298
		(+)
		0
		(-)
		720
		(=)
		3578
		

		3564
		-14
		

		

		

	

	

		12
		3564
		(+)
		0
		(-)
		626
		(=)
		2938
		

		2946
		8
		

		

		

	

	

		13
		2946
		(+)
		0
		(-)
		670
		(=)
		2276
		

		2253
		-23
		

		

		

	

	

		14
		2253
		(+)
		0
		(-)
		259
		(=)
		1994
		

		1960
		-34
		

		

		

	

	

		15
		1960
		(+)
		0
		(-)
		182
		(=)
		1778
		

		1860
		82
		

		

		

	

	

		16
		1860
		(+)
		0
		(-)
		353
		(=)
		1507
		

		1513
		6
		

		

		

	

	

		17
		1513
		(+)
		7600
		(-)
		391
		(=)
		8722
		

		8761
		39
		

		

		

	

	

		18
		8761
		(+)
		0
		(-)
		805
		(=)
		7956
		

		7944
		-12
		

		

		

	

	

		19
		7944
		(+)
		0
		(-)
		362
		(=)
		7582
		

		7575
		-7
		

		

		

	

	

		20
		7575
		(+)
		0
		(-)
		360
		(=)
		7215
		

		7207
		-8
		

		

		

	

	

		21
		7207
		(+)
		0
		(-)
		183
		(=)
		7024
		

		7028
		4
		

		

		

	

	

		22
		7028
		(+)
		0
		(-)
		171
		(=)
		6857
		

		6852
		-5
		

		

		

	

	

		23
		6852
		(+)
		0
		(-)
		292
		(=)
		6560
		

		6536
		-24
		

		

		

	

	

		24
		6536
		(+)
		0
		(-)
		470
		(=)
		6066
		

		6096
		30
		

		

		

	

	

		25
		6096
		(+)
		0
		(-)
		579
		(=)
		5517
		

		5918
		401
		

		

		

	

	

		26
		5918
		(+)
		0
		(-)
		578
		(=)
		5340
		

		4948
		-392
		

		

		

	

	

		27
		4948
		(+)
		0
		(-)
		477
		(=)
		4471
		

		4462
		-9
		

		

		

	

	

		28
		4462
		(+)
		0
		(-)
		423
		(=)
		4039
		

		4027
		-12
		

		

		

	

	

		29
		4027
		(+)
		0
		(-)
		201
		(=)
		3826
		

		3805
		-21
		

		

		

	

	

		30
		3805
		(+)
		0
		(-)
		0
		(=)
		3805
		

		3805
		0
		

		

		

	

	

		

		TOTAL GALLONS DELIVERED
		->
		14900
		 
		13110
		<-
		TOTAL GALLONS PUMPED
		

		TOTAL GALLONS OVER OR SHORT
		>
		362
		 
		

		

	

	

		MATH CHECK
		Start Stick
		 
		/l\
		/l\
		 
		End Stick
		

		/l\
		

		

	

	

		l
		l
		l
		

		                                                                                                                                                                                                                                                               
	

	

		\l/
		\l/
		\l/
		

		

	

	

		1653
		+
		14900
		-
		13110
		=
		3443
		=
		3443
		=
		3805
		-
		362
		

		

	

	

		

		

		/l\
		

		

	

	

		l
		TOTAL GALLONS OVER OR <<SHORT
		

		

	

	

		LEAK CHECK
		 TOTAL GALLONS PUMPED X 0.01 = 
		131
		+
		130
		=
		261
		compare to
		\l/
		

		

	

	

		362
		

		

	

	

		

		

		

	

	

		Is the "TOTAL GALLONS OVER OR SHORT" LARGER than "LEAK CHECK" result?    
		

		

	

	

		#VALUE!
		

		

	

	

		If answer is "YES" INITIATE A SUSPECTED RELEASE INVESTIGATION as per Chaper 245.304
		

		

	

	

		PRINT AND KEEP THIS PIECE OF PAPER ON FILE FOR AT LEAST 1 YEAR
The words contained in this file might help you see if this file matches what you are looking for:

...Sheet blank form monthly inventory record developed by pennsylvania department of environmental protection ver facility name id tank number amp type fuel size month year date water check level inches start stick gallons delivered pumped book end stickatg daily over or short quot initials previous x value total gt lt math l leak compare to is the larger than result if answer yes initiate a suspected release investigation as per chaper print and keep this piece paper on file for at least ex op days walt s gas gogo k gasoline premium february...

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Posted on: 16 Aug 2022 | 3 years ago
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