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QUARTERLY INVcNTORY REPORTING <br />Facility Name: % "�(% d,11 <br />Facility Address: <br />City: <br />County; <br />State: <br />�—� I hereby certify under penalty of perjury that all product <br />Ulevel variations for the above mentioned facility were <br />within allowable limits for this quarter. <br />Inventory variations exceeded the allowable limits for <br />❑this quarter. I hereby certify under penalty of p <br />that the source for the variation was NOT due to � <br />unauthorized (leak) release. <br />gll_ �. <br />List date. tank t and amount for all variations <br />that exceed the allowable limits EN���'v�����`N ER i'��,��r� <br />a=RPJ11! I SE.tVCES <br />1. �27� 1. � <br />The quarterly summary report shall be submitted within 15 days <br />of the end of each quarter. <br />Quarter i — January thru March Submit by April iS <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 Janaury/is <br />Send To (Local Agency)- T <br />Ili <br />KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br />DATE MAILED <br />�i <br />ROM <br />ff ..I <br />Kwr <br />�—� I hereby certify under penalty of perjury that all product <br />Ulevel variations for the above mentioned facility were <br />within allowable limits for this quarter. <br />Inventory variations exceeded the allowable limits for <br />❑this quarter. I hereby certify under penalty of p <br />that the source for the variation was NOT due to � <br />unauthorized (leak) release. <br />gll_ �. <br />List date. tank t and amount for all variations <br />that exceed the allowable limits EN���'v�����`N ER i'��,��r� <br />a=RPJ11! I SE.tVCES <br />1. �27� 1. � <br />The quarterly summary report shall be submitted within 15 days <br />of the end of each quarter. <br />Quarter i — January thru March Submit by April iS <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 Janaury/is <br />Send To (Local Agency)- T <br />Ili <br />KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br />DATE MAILED <br />