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QUARTERLY( INVENTORY REPORTING <br /> Facility Name: <br /> � l I Tank Size Product <br /> 1:3,000 <br /> Facility Address: �] �� Lw ICL (k <br /> City: ic) k- VD, ) I Ia. coo <br /> County: S -) <br /> State: r <br /> Waste oil <br /> I hereby certify under penalty of perjury that all produ4 <br /> alevel variations for the above mentioned facility were <br /> within allowable limits for this quarter. J U L 19 1983 <br /> Inventory variations exceeded the allowable limits for <br /> ❑ this quarter. I hereby certify under penalty of <br /> that the source for the variation was NOT due to an PER[-.i iVQERV1'-P" <br /> unauthorized (leak) release. <br /> List date, tank f 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 end of each quarter. <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) : — E J L18AJt4L Q I-STWL <br /> I ter) 1 a/-el J= CiA-0 <br /> KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br /> DATE MAILED - 9- q -99 <br />