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r1 E t <br /> QUARTERLY I NVcNTORY REPORT�� G rlln, <br /> :.fv`�'IR0NVciVI'AL H�_ALTH <br /> Tank # t <br /> Product <br /> Faci1ity Name: qq ti�r� _ <br /> Facility Address: -1�CX�� M�fe C - C, <br /> City: ato�L ,1 <br /> County: <br /> State: - <br /> Haste oil <br /> I hereby certify under penalty of perjury that all product <br /> nlevel variations for the above mentioned facility were <br /> l-- within allowable limits for this quarter. <br /> Inventory variations exceeded the allowable limits for <br /> F1 <br /> this quarter. I hereby certify under penalty of perjury <br /> that the source for the variation was NOT due to an <br /> unauthorized (leak) release. <br /> List date. tank E and amount for all variations <br /> that exceed the allowable limits <br /> Date Tank # Amount Date Tank E Amount <br /> The quarterly summary report shall be submitted within 0 days <br /> of the end of each quarter. <br /> Quarter i — January thru March Submit by April 15 <br /> Quarter 2 — April thru .June Submit by July iS <br /> Quarter 3 — July thru September Submit by October 15 <br /> Quarter 4 — October thru December — Submit by Janaury 15 <br /> Send To (Local Agency) : 6L Ck, � <br /> (r� b4Az� w <br /> rl�,n C�- . <br /> KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br /> DATE MAILED �� �/ <br />