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QUARTER INVENTORY PORTING`7ISM <br />Facility Name: <br />Facility Address: <br />city: <br />County: J <br />State: C.� <br />These were inventory variations that <br />❑ exceeded the allowable limits for this <br />quarter. <br />LIST DATE, TANK # AND AMOUNT FOR ALL VARIATIONS <br />THAT EXCEED THE ALLOWABLE LIMITS. <br />Date I Tank # I Amount I Explanation <br />Tank # <br />Size <br />Product"-" • <br />Shell Oil notified. <br />Step 4 <br />Records review from <br />�71 <br />CIO <br />(J <br />situation. <br />Step 5 <br />Physical facilities <br />inspected for leaks. <br />Step 6 <br />Dispenser meters <br />calibrated. <br />Step 7 <br />Piping hydrostatically <br />tested. <br />Step 8 <br />Waste Oi I <br />I hereby certify that all product level variations <br />for the above mentioned facility were <br />within allowable limits for this quarter. <br />OUT OF TOLERANCE <br />INVESTIGATIVE STEPS <br />Step 1 Review Records . <br />Step 2 New reconciliation <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 />t1 Quarter 4 — October thru December <br />Submit by January 15 <br />Send to (Local Agency): S- <br />R ? D� <br />KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br />DEALER SIGNATURE DATE <br />performed. <br />Step 3 <br />Shell Oil notified. <br />Step 4 <br />Records review from <br />the last stable <br />situation. <br />Step 5 <br />Physical facilities <br />inspected for leaks. <br />Step 6 <br />Dispenser meters <br />calibrated. <br />Step 7 <br />Piping hydrostatically <br />tested. <br />Step 8 <br />Underground storage <br />tanks precision tested. <br />Step 9 <br />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 />t1 Quarter 4 — October thru December <br />Submit by January 15 <br />Send to (Local Agency): S- <br />R ? D� <br />KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br />DEALER SIGNATURE DATE <br />