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1"ervlce Station Number <br />t <br />Address <br />3 (4 YQ • <br />�-- I <br />,ealer/Station Manager <br />R^d Used -oil tank size (Gallon) 1 a -v <br />Period Covered 3 [ Z TO <br />beginning of Static Period <br />End of Static Period <br />Exceed (3/16' for 1,000 <br />level Change Allowance? gallon tank; <br />Date <br />Time <br />Used -Oil LevelUsed-Oil <br />(Inches) (L) <br />Date <br />Time <br />level <br />(inches) (L) <br />(L - L) (Y/N) 5/16* for <br />SSO gallon tank) <br />----------------- <br />V'O <br />-I <br />4. 3 <br />q oa <br />1 <br />14--1 <br />IDO <br />y -Z, <br />&30 <br />f 1 !'0201 <br />H ®2, <br />�- <br />S-2 1 <br />/ <br />1 c. l'� G <br />0 Q N <br />rw V �. ! <br />® <br />cs♦ `I4 <br />ka <br />Z 11"01) <br />t DD <br />f �Zw <br />`- Z I <br />I s"" <br />S <br />4-Z4 °f Ulm <br />yz <br />P-1 <br />to 3co <br />,. <br />I <br />f <br />yy <br />w <br />1 3e0 <br />V'+ <br />6 3V <br />B 0 <br />Mote: Minimum static period 48 hours, maximum 7 days <br />%I certify, under pe <br />of rjury, that the above riFpfd is an accurate and complete account of my used -oil tank activity. <br />Date <br />Signed <br />Dealer/Station Manager <br />