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QUARTERLY INVcN-TORY REPORTING <br /> �IQ �hell Tank +� Size Product <br /> Facility Name: ; <br /> Facility Address: -1 MDre,la CLC <br /> City: "DtDa JOb, CA <br /> County: � <br /> State: 0-A <br /> Waste oil <br /> I hereby certify under penalty of perjury that all product <br /> level 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 perjury <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 - .ALP-l' <br /> of the end of each quarter. =.RMIT/SERVICES <br /> Quarter i – 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 Janaury 15 <br /> Send To (Local Agency) : X46-,J tJ1` pp-�.)T <br /> KEEP COPIES OF THIS FORM FOR YOUR OWN RECOROS <br /> DATE MAILED <br />