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QUARTER Y INVENTORY &PORTING <br /> Facility Name: <br /> /(k/Y`0yItI , Tank# Size Product <br /> 00 <br /> Facility Address: �f?�� �� � �X ��t 70 l> U <br /> City: ,rrr�2 � 'S-006 0� <br /> County: c��,• r17� <br /> nn 'T, tF <br /> State: :.,, <br /> ..VVa e :� . u <br /> ` J J <br /> These were inventory variations that I hereby certify .tl� t rpiu�trl�rv, el v ri a.tions <br /> ❑ exceeded the allowable limits for this for the above meh1#:UQP'U1 "Cef�t L I �� <br /> quarter. within allowable lirrti'tsiti�lthi� 'dff .� <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 /> VQuarter 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): JU <br /> KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br /> DEALER SIGNATURE DATE <br />