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L.-.3 QUARTER...Y INVENTORY DEPORTING <br /> d b <br /> Facility Name: c Cao n na p� Tank # Size Product <br /> �J l.J /�, . l .l'1n�w' en /e 6n <br /> j Facility Address: _ )� <br /> City: 02 /d OEL <br /> County: C�i a/n <br /> /d <br /> _ State: Lin nn <br /> Waste Oil <br /> �tlese were inventory variations that I hereby certify that all product level variations <br /> xceeded the allowable limits for this ❑ for the above mentioned facility were <br /> quarter. 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 /> 7 S, 7/y performed. <br /> Step 3 Shell Oil notified. <br /> 3 '(c3.2a Step 4 Records review from <br /> the last stable <br /> SS a _a situation. <br /> Step 5 Physical facilities <br /> a2 + D inspected for leaks. <br /> 3 } / r Step 6 Dispenser meters <br /> D calibrated. <br /> 52 ;,p f "L• Step 7 Piping hydrostatically <br /> t-2 nj,,j tested. <br /> Step 8 Underground storage <br /> 9 1992 tanks precision tested. <br /> L H'_,,,1.TISStep 9 Additional investigation <br /> �+ k�MItd4Grtwl�co 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 /> 3 - a the quarter you are submitting <br /> 1%2q ❑ Quarter 1 — January thru March <br /> _S 7Sg Submit by April 15 <br /> ❑ Quarter 2 — April thru June <br /> 9`J9 / Submit by July 15 <br /> A -puarter 3 — July thru September <br /> Submit by October 15,9Z <br /> ❑ Quarter 4— October thru December <br /> Submit by January 15 <br /> Send to (Local Agenc «OJt i <br /> Lan t <br /> 4:x�_tr- r r a/2 <br /> KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br /> DEALER SIGNATURE DATE <br /> G <br />