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QUARTEALY INVENTORY REPORTING <br /> Facility Name: I �� ,�)�G i�dc -' S/L e Tank # SizeMProtduct <br /> bo <br /> Facility Address: //% 7 / 0 - /l)H iiJ <br /> =x 9 0 <br /> City: /7)f}�J%e&,e Ue <br /> County: �!�-/1 i?�A�v� �� �State: <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 /> Step 1 Review Records . <br /> Date Tank# Amount Explanation Step 2 New reconciliation <br /> al 1 -+] t C c, , performed. <br /> Step 3 Shell Oil notified. <br /> ^i Step 4 Records review from <br /> fi /a f�S /cam, the last stable <br /> situation. <br /> Step 5 Physical facilities <br /> 7 3 t ail s to a inspected for leaks. <br /> Step 6 Dispenser meters <br /> calibrated. <br /> Step 7 Piping hydrostatically <br /> tested. <br /> Step 8 Underground storage <br /> tanks precision tested. <br /> Step 9 Additional investigation <br /> 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): )-I'r A I <br /> Ile 2-e /T-& <br /> KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br /> DEALER SIGNATURE DATE <br />