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QUARTERLY INVENTORY REPORTING <br /> 0 &j &Le-� <br /> / <br /> Facility Name: �2 6 � a 4(17F ,1 1 D 1 y Tank # Size Product <br /> Facility Address <br /> City: / CPP) l <br /> County: Jn /71 <br /> State: ( Ce 6 <br /> Waste Oil <br /> These were inventory variations that I hereby certify that all product level variations <br /> ❑ exceeded the allowable limits for this ❑ for the above mentioned facility were <br /> quarter. /6�LL-1z C(C�? ij y within allowable limits for this quarter. <br /> LIST DATE, TANK # AND AMOUNT FOR ALL VARIATIONS OUT OF TOLERANCE <br /> THAT EXCEED THE ALLOWABLE LIMITS. INVESTIGATIVE STEPS <br /> Step 1 Review Records . <br /> Date Tank # Amount Explanation Step 2 New reconciliation <br /> - (�/(� performed. <br /> t,2 <br /> _ / Step 3 Shell Oil notified. <br /> Step 4 Records review from <br /> Cd the last stable- situation. <br /> Step 5 Physical facilities <br /> - inspected for leaks. <br /> �G Step 6 Dispenser meters <br /> calibrated. <br /> 3 �L, Step 7 Piping hydrostatically <br /> tested. <br /> Step 8 Underground storage <br /> •> tanks precision tested. <br /> APR 16 Tal Step 9 Additional investigation <br /> KNVIRONMIENTAL HEALI as required by Shell <br /> or the local agency. <br /> This quarterly summary report <br /> shall be submitted within 15 days <br /> after the end of each quarter. Check <br /> the quarter you are submitting <br /> ❑ Quarter 1 — January thru March <br /> Submit by April 15 <br /> ❑ Quarter 2 — April thru June <br /> Submit by July 15 <br /> ❑ Quarter 3 — July thru September <br /> Submit by October 15 <br /> ❑ Quarter 4— October thru December <br /> Submit by January 15 <br /> Send to (Local Agency): .- //?1 LW42LJ '4-' <br /> L'UJm, L�4 15-N- <br /> KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br /> DEALER SIGNATURE DATE <br />