Laserfiche WebLink
QUARTER, INVENTORY AHPORTING <br /> Facility Name: Tank # Size Product <br /> j�(.�" l��Lr!n� S' :-LU <br /> '7 /' 1 ���C'� 0 SC'/-) i. �e <br /> Facility Address: % ( { <br /> // /� ��C ey <br /> -z_ -S-00o J< o <br /> city: j� JL3 5 U v b ) cls <br /> County: �� <: a v G L, <br /> imW ��—Idemu <br /> State: d Am Q q 19q: <br /> ENVIRONMENTAL HEALTH I Waste Oil <br /> These were inventory varix% N1,i{fy�jFRViGF5 /1 hereby certify that all product level variations <br /> El exceeded the allowable limits for this ER 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 /> performed. <br /> Step 3 Shell Oil notified. <br /> Step 4 Records review from <br /> the last stable <br /> situation. <br /> Step 5 Physical facilities <br /> 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 /> L- Quarter 4— October thru December <br /> Submit by January 15 <br /> Send to (Local Agency): J ', L <br /> P CS -2— <br /> KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br /> DEALVN SIGNATURE DATE <br />