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QUARTERLY INVENTORY REPORTING <br /> Facility Name: Tank I Size lPraduct <br /> 0� (LC2:, <br /> Facility Address ' � <br /> City: . ZB <br /> County: �� <br /> State: <br /> Waste 011 <br /> F] I hereby certify under penalty of perjury that all product <br /> level variations for the above mentioned facility war <br /> within allowable limits for this quarter. ECEIVE <br /> Inventory variations exceeded the allowable limits to <br /> this quarter. I hereby certify under penalty of perjury JUL 1 8 1930 <br /> that the source for the variation was NOT due to an ENVIRONMENTAL HEALTH <br /> unauthorized (leak) release. PERPOIT/SERVICES <br /> List date. tank t and amount for all variations <br /> that exceed the allowable limits <br /> Date Tank f Amount Date Tank f Amount <br /> The quarterly summary report shall be submitted within 15 days <br /> of the end of each quarter. <br /> Quarter i — January thru March — Submit by April 15 <br /> Quarter 2 — April thru June Submit by July 15 <br /> Quarter 3 — July thru September — Submit by October 15 <br /> Quarter 4 — October thru December — Submit by Janaury iS <br /> Send To (Local Agency) : f J 61`72r- /2 7`� PC�-' - <br /> T p <br /> KEEP COPIES ,OF /THIS FORM FOR YOUR OWN RECORDS <br /> DATE MAILED !y ` � <br />