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• <br /> QUARTERLY INVENTORY R ORTING <br /> Facility Name: �q _djuM Tank Size Product <br /> L CCC <br /> Facility Address: _1100 Hord L4 <br /> City: <br /> County: <br /> State: <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 /> F] 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 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 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) : <br /> KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br /> DATE MAILED �� <br />