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- 06ARTEHOLY INVENTORY PORTING <br /> C ' Facility Name: tiJs � ImWaste <br /> Facility Address: .JL21 NJ N�� S� <br /> County: <br /> State: - (-A . <br /> ❑ I hereby certify under penalty of perjury that all product <br /> level variations for the above mentioned facility werelZ� ' <br /> within allowable limits for this quarter. <br /> Inventory variations exceeded the allowable limits for ~ <br /> this quarter. I hereby certify under penalty of perjury JUL 1 3 19£^ <br /> that the source for the variation was NOT due to an <br /> unauthorized (leak) release, I'O'v1nEPd;AL <br /> List date, tank f and amount for all variations <br /> that exceed the allowable limits <br /> Date Tank Amount Date Tank f Amount <br /> - <br /> � ' f-SdJopc) <br /> 0, <br /> a a ?0 - <br /> 'J <br /> no <br /> The quarterly summary report shall be submitted within 15 days <br /> of the end of each quarter. <br /> Quarter i — January thru March -- Submit by April 15 <br /> Quarter 2 — April thru June Submit by July 15 <br /> Quarter 3 — July thru September — Submit by October 15 <br /> Quarter 4 — October thru December — Submit by Janaury 1S <br /> Send To (Local Agency) : <br /> KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br /> DATE MAILED I <br />