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QUARTEAY INVENTORY IkEPORTING <br /> Facility Name: r7I�L S �I I Tank # Size Product <br /> Facility Address: <br /> City: N :d <br /> County: <br /> State: <br /> c.CJ 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. 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 /> Date Tank # AmountStep 1 Review Records . <br /> Explanation Step 2 New reconciliation <br /> performed. <br /> I 1 <br /> 4 Step 3 Shell Oil notified. <br /> 4- Step 4 Records review from <br /> the last stable <br /> a I situation. <br /> Step 5 Physical facilities <br /> inspected for leaks. <br /> Step 6 Dispenser meters <br /> calibrated. <br /> Step 7 Piping hydrostatically <br /> tested. <br /> Step 8 Underground storage <br /> AN tanks precision tested. <br /> Step 9 Additional investigation <br /> F; as required by Shell <br /> PERA T/`" RVI 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 /> ff Submit by January 15 <br /> Send to (Local Agency):�Anl . 1f�q�,` In �a l F}F� 11� �I <br /> E S( <br /> �A � L+� , f <br /> KE COPIES F THIS FORM FOR YOUR R C RDS <br /> ` <br /> D L R SIGNATURE DATE <br />