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(moi <br />QUARTERLY INVENTORY #EPORTING <br />Facility Name:.f,�(j <br />Facility Address. <br />City: <br />County: S =� <br />State: <br />These were inventory variations that <br />❑ exceeded the allowable limits 19rt-1this`; 1992 <br />quarter. <br />�NVIRQMMENTAL HEAL!, -1 <br />LIST DATE, TANK # AND AMOUNT FOR ALL VARIATIONS <br />THAT EXCEED THE ALLOWABLE LIMITS. <br />Tank # <br />Size <br />Product <br />New reconciliation <br />-200 0 <br />S a•l, s' <br />Z <br />Shell Oil notified. <br />C L <br />Records review from <br />d� <br />the last stable <br />6 <br />S <br />Additional investigation <br />as required by Shell <br />or the local agency. <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 />I Date I Tank # I Amount I Explanation I <br />OUT OF TOLERANCE <br />INVESTIGATIVE STEPS <br />Step 1 <br />Review Records . <br />Step 2 <br />New reconciliation <br />performed. <br />Step 3 <br />Shell Oil notified. <br />Step 4 <br />Records review from <br />Step 8 <br />the last stable <br />situation. <br />Step 5 Physical facilities <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 />R 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 />0 <br />Send to (Local Agency): <br />6 B Z00q <br />KEEP COPIES F THIS FORM FOR YOUR RECORDS <br />DEALER SIGNA RE DATE <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 />R 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 />0 <br />Send to (Local Agency): <br />6 B Z00q <br />KEEP COPIES F THIS FORM FOR YOUR RECORDS <br />DEALER SIGNA RE DATE <br />