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ltE <br />T CEIV <br />TANK GAUGING AND INVENTORY RECONCILIATION <br />ANNUAL SUMMARY REPORT FEB 0 3 1993 <br />ENVIRONMENTAL HEALTH <br />Facility Name and Address: Date: 111 -5 -Ali PERMIT/SERVICES <br />301 KeP!erran Lane <br />Check which method report is for. ZInventory Reconciliation(MotorVehicleFuel) <br />Manual Tank Gauging (Used Oil Tanks) <br />' I hereby certify under penalty of perjury that all inventory variations each month, <br />for the above mentioned facility, were within allowable limits, for the year /Y 7nZ <br />Inventory variations exceeded the allowable limits for the year. <br />I hereby certify under penalty of perjury that the source for the variation was not <br />due to an unauthorized release. <br />List month, tank #, and amount of variation for each month that the variation exceeded the <br />allowable limits. <br />Month <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />Tank # <br />Amount of Variation <br />Additional months shall be continued o heet of paver and attached. <br />Operator Signature: <br />If the source of the variation which exceeds the California allowable limits was due to a leak, the <br />incident shall be reported to the local underground storage tank agency within 24 hours. An <br />unauthorized Release Report shall be submitted within 5 days. <br />For stations utilizing Inventory Reconciliation or Manual Tank Gauging this report must be <br />submitted to the local Underground Storage Tank Regulation Agency on an annual basis. <br />01992-1 (1-23-92) <br />