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QUARTERLY INVENTORY R ORTING <br /> ,-P,Lkn Facility Name: <br /> <' k�_d Tank f Size Product <br /> LLTU <br /> Facility Address: L';4 11 f� �_&y)h p <br /> City: S G9C firm <br /> County: .\ 1� - <br /> State: �o <br /> Waste all <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 /> F1this 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 # Amaunt Date Tank Amount <br /> The quarterly sucmnary report shall be submitted within iS days <br /> of the and 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 />