ADEM Form 414 – Fill Out and Use This PDF

SIRM O N

ADEM MONTHLY STATISTICAL INVENTORY RECONCILIATION (SIR) REPORT FOR THE MONTHLY PERIOD FROM ___/___/___ TO ___/___/___

INSTRUCTIONS

1.If, for any reason, the test is neither “pass” nor “fail”, the “inconclusive” column must be marked under the "SIR Monthly Results" section below.

2.For “Leak Threshold”, “Minimum Detectable Leak Rate”, and “Estimated Leak Rate”, values must be in gallons per hour (gph).

3.When required by the "Reporting and Recordkeeping Requirements" section below, a completed ADEM Monthly SIR Report form should be sent to

	the following address:	Alabama Department of Environmental Management
		Groundwater Branch/UST Compliance Unit
		Post Office Box 301463
		Montgomery, Alabama 36130-1463
		OWNER INFORMATION

Facility Name:

Owner:

Address:

Address:

City, State, Zip Code:

City, State, Zip Code:

Facility I.D. No.:

Phone Number: (

)

-

VENDOR INFORMATION

SIR Vendor:

Phone Number: (

)

-

SIR Vendor Contact:

SIR Version:

SIR MONTHLY RESULTS

THIS MONTHLY PERIOD

LAST MONTHLY PERIOD

ADEM

Tank

Tank

No. days

Leak

Minimum

Estimated

p

f

i

p

f

i

Unique

Contents

Capacity

of

Threshold

Detectable

Leak Rate

a

a

n

a

a

n

tank no.

(gallons)

inventory

(LT)

Leak Rate

(ELR)

s

i

c

s

i

c

data

(1)

(MDL)

(3)

s

l

o

s

l

o

(2)

(4)

(5)

n

(4)

(5)

n

(6)

(6)

(1)The Required Performance Standard (RPS) must be no greater than 0.2 gph. The SIR Vendor may set the RPS lower if desired.

(2)The Leak Threshold (LT) is normally set at one half of the RPS by the SIR Vendor and third-party certified at that level. However, the LT may be set at any level below the RPS by the SIR Vendor and third-party certified at that level.

(3)The Estimated Leak Rate (ELR) is the calculated amount the tank appears to be losing.

(4)A “pass” occurs when the ELR is less than the LT and the MDL is less than or equal to the RPS.

(5)An “inconclusive” occurs when the ELR is less than the MDL and the MDL is greater than the RPS.

(6)A “fail” occurs EITHER when the ELR is greater than or equal to the LT and the MDL is less than or equal to the RPS OR when the ELR is greater than or equal to the MDL and the MDL is greater than the RPS.

REPORTING AND RECORDKEEPING REQUIREMENTS

1.If any monthly SIR Vendor report indicates a “fail” or "inconclusive" for any tank system, you are required to:

(a)Perform an investigation of all tank systems that SIR Vendor indicates a "fail" or "inconclusive" within 7 days after receipt of SIR Vendor report.

2.If above investigation indicates that a suspected release caused the tank system(s) “fail” or "inconclusive" report, you are also required to:

(a)Report a suspected release to ADEM at 334/270-5655 within 24 hours after completion of investigation;

(b)Perform a tightness test on tank system(s) with a suspected release within 7 days after completion of above investigation;

(c)Submit system tightness test results, results of investigation and completed ADEM Monthly SIR Report form to ADEM within 10 days after completion of above investigation.

3.If above investigation indicates that factors other than a suspected release caused the tank system(s) “fail” or "inconclusive" report, you are only required to:

(a)Submit results of investigation and completed ADEM Monthly SIR Report form to ADEM within 10 days after receipt of SIR Vendor report.

4.If above investigation indicates that factors other than a suspected release caused the tank system(s) “fail” or "inconclusive" report, and a second consecutive monthly SIR Vendor report indicates that the same tank system did not "pass" ("fail" or "inconclusive"), you are required to:

(a)Report a suspected release to ADEM at 334/270-5655 within 24 hours of receipt of the second SIR Vendor report;

(b)Perform a tightness test on the tank system(s), where SIR Vendor report indicated the same tank system(s) did not "pass", within 7 days of receipt of the second SIR Vendor report;

(c)Submit system tightness test results and completed ADEM Monthly SIR Report form to ADEM within 10 days after receipt of the second SIR Vendor report that indicated the same tank system(s) did not "pass".

5.The tank owner is required to have an ADEM Monthly SIR Report form for each tank system on file 20 days after the monthly test period.

6.A Leak Threshold (LT), Minimum Detectable Leak Rate (MDL), and Estimated Leak Rate (ELR) must be on file for each tank. If they are not provided, the tank system(s) is not in compliance with leak detection requirements for that month.

CERTIFICATION

I certify under penalty of law that I am familiar with the information submitted on this form and that based on my inquiry of those individuals immediately responsible for obtaining the information I believe that the information is true, accurate, and complete.

Signature of owner/operator:________________________________________________________________________Date:______________________

ADEM Form # 414 8/02

Issue Date: 5/28/99