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• <br />• <br />i <br />, QUARTERLY INVENTORY REPORTING <br />Facility Namet 1( <br />Facility Address��'7-) <br />City: S Fa To;I'v <br />County: t'hN J�)Ah��'�i <br />State: <br />T <br />Tank ! Size Product <br />Baste 011 <br />F-1 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 />RI IV* <br />this quarter. I hereby certify under penalty of per X CIL <br />that the source for the variation was NOT due to an <br />unauthorized (leak) release. OCT 2 7 1989 <br />List date, tank # and amount for all variation6NVIRONMENTAL HEA!? H <br />that exceed the allowable limits PERM1T/S-LRVu,-S <br />D -I �1� Wt <br />© �� <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): <br />KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br />DATE MAILED <br />