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QUARTERL� INVEN'PORY REkRTING <br />Facility Name: l�2fGGi S// ey, Tank Size Product <br />Facility Address: -:?? ,r T�-%�% r Z- <br />City: 3 p0Gd <br />County: d <br />State: �— <br />I /U .diff' i waste oil I <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 />❑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 4 and -amount for all variations <br />that exceed the allowable limits <br />Oate Tank # Amount Date Tank # Amount <br />The quarterly summary report shall be submitted within 15 days <br />of the and of each quarter. <br />Quarter i•— January thru March Submit by April i5 <br />Quarter 2 — April thru June Submit by July 0 <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 YOUB OWN RECOHOS <br />