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QUARTERLY INVENTORY F,cPORTING <br />Facility Name: <br />Facility Address: <br />City: c <br />County: <br />State: <br />These were inventory <br />❑ exceeded the allowable <br />quarter. <br />variations that <br />limits for this <br />LIST DATE, TANK # AND AMOUNT FOR ALL VARIATIONS <br />THAT EXCEED THE ALLOWABLE LIMITS. <br />Date Tank # Amount Explanation <br />Tank # <br />Size <br />Product <br />Shell Oil notified. <br />d U <br />o Q v <br />k - <br />situation. <br />06o <br />u. <br />u <br />60 0 <br />2r,/ <br />Dispenser meters <br />calibrated. <br />Step 7 <br />Piping hydrostatically <br />tested. <br />—� <br />Waste Oil <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 />X'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):�� <br />U Z00`� <br />ST tt 9 S' z o � <br />KEEPOP S OF THIS FORM FOR YOUR RECORDS <br />DEALER SIG URE 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 />X'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):�� <br />U Z00`� <br />ST tt 9 S' z o � <br />KEEPOP S OF THIS FORM FOR YOUR RECORDS <br />DEALER SIG URE DATE <br />