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! QUARTERLY INVENTORY REPORTING <br /> ���� �'U�J�U'� Tank # Size Product <br /> Facility Name: <br /> &W O <br /> Facility Address: �< < ti S7-el-00 <br /> City: . <br /> County: <br /> State: Ca— <br /> waste oil <br /> I hereby certify under penalty of perjury that all product <br /> level variations for the above mentioned facility were <br /> F/I <br /> e _ . . <br /> within allowable limits for this quarter. <br /> Inventory variations exceeded the allowable limits for <br /> F] <br /> this quarter. I hereby certify under penalty of perjury 5 <br /> that the source for the variation was NOT due to an <br /> unauthorized (leak) release. <br /> List date, tank # and amount for all variations <br /> that exceed the allowable limits <br /> Date Tank # Amount Date Tank # amount <br /> The quarterly summary report shall be submitted within 15 days <br /> of the and of each quarter. <br /> Quarter 1 — January thru March -- Submit by April 15 <br /> Quarter 2 — April thru June Submit by July 15 <br /> Quarter 3 — July thru September Submit by October 15 <br /> Quarter 4 — October thru December — Submit by JaRaury 15 , <br /> Send To (Local Agency) : <br /> l� CG �75crv- Zyoq <br /> KEEP COPIES OF THIS FORM FOR YOUR OWN RECOROS <br /> DATE MAILED <br />