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BE COMPLETED UJAR=Y <br /> UNOCAL0 <br /> QUARTERLY REPORT <br /> Facility Name : Tank# Size Product <br /> Facility Address : <br /> ❑ 1 hereby certify under penalty of perjury that all product level <br /> variations for the above mentioned facility were Within allowable <br /> l i m i`i s f o r t h i s quarter . (No in Column 13, Inventory Reconciliation <br /> Sheet, or Column G, Tank Gaugirg Sheet, or no excessive liquid in the Tank <br /> Annular Space or Piping Trench Liner.) <br /> F—I <br /> Inventory variations exceeded the allowable limits for this quarter . <br /> I hereby certify under penalty of perjury that the source for the <br /> variation was not due to an unauthorized ( leak) release . (Yes in <br /> Column G of the Tank Gauging Sheet . ) <br /> List date , tank # , and amount for all variations that exceeded <br /> the allowable limits: <br /> Date Tank # Amount <br /> The quarterly summary report shall be submitted within 15 days of the end of <br /> each quarter . <br /> Quarter 1 - January --> March --submit by April 15 <br /> Quarter 2 - April --> .lune ---shit by July 15 <br /> Quarter 3 - July --> September —submit by October 15 <br /> Quarter 4 - October --> December —submit by January 15 <br /> Send to : <br /> (Local .Agency) <br /> KEEP COPIES OF THESE FORMS FOR YOUR CWN RECORDS. <br /> Include the following forms if applicable: Inventory Reconciliation Sheet; <br /> Waste Oil Tank Gauging Sheet; Secondary Contairm-ent Recording Sheet; <br /> Release Evaluation Checklist; Unauthorized Release Report. <br /> Page 12A <br />