
Submit to: Kansas Department of Health and Environment Bureau of Environmental Remediation Storage Tank Section 1000 SW Jackson, Suite 410, Topeka KS 66612-1367 Please Print Clearly or Type Inventory Control Leak Check Water Check Date yes no yes no yes no Signed I. Inventory Control Annual Summary Sheet is due to KDHE by February 28, 2017. Please attach a copy of your December 2016 Inventory Control record to this sheet. II. Facility Information A. Facility.
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How to fill out the KS UST C009 online
The KS UST C009 form is essential for submitting the Inventory Control Annual Summary Sheet to the Kansas Department of Health and Environment. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently.
Follow the steps to fill out the KS UST C009 online
- Click the ‘Get Form’ button to obtain the form and open it in the online editor.
- Begin by filling in the KDHE Reference No., Owner I.D., and Facility I.D. at the top of the form. Ensure to print clearly or type when entering your information.
- Proceed to fill in Section II, providing the facility information including Facility Name and Facility Address. Include a Contact Person's name and phone number.
- In Section III, provide the Owner Information, including Owner Name and Owner Address. Again, include a Contact Person's name and phone number.
- In Section IV, fill in the Tank No. and Total Capacity, while also specifying whether a water check is passed (Yes/No).
- Section V requires you to indicate the Substance Stored. Be specific about the grade of the substance (e.g., E-10, Biodiesel).
- For Section VI, input the total gallons pumped for each month. Calculate the EPA Leak Check by multiplying the total gallons pumped by 0.01 and adding 130 gallons. Input the results for each month in the designated fields alongside the Total Over/Short.
- In Section VII, identify the month with the greatest total gallons pumped along with the number of gallons for that month.
- Review all sections for accuracy and completeness. Remember to keep a copy of your December Inventory Control record attached to this sheet before final submission.
- Once completed, save changes, download, print, or share the form as required, and submit it to the Kansas Department of Health and Environment at the designated address.
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