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L� <br />OUARTEFt.Y INVENTORY IIEPORTING <br />Facility Name: Facility Address: Sill -2Ee <br />City: )a AW <br />County: <br />state: <br />These were inventory vafiWORONIVIRNTAL b <br />HEALT1I hereby certify that all product level variations <br />exceeded the allowable limitSPMAW /SERVICES for the above mentioned facility were <br />quarter. within allowable limits for this quarter. <br />OUT OF TOLERANCE <br />INVESTIGATIVE STEPS <br />Step I Review Records . <br />Step 2 New reconciliation <br />performed. <br />Step 3 Shell Oil notified. <br />Step 4 Records review from <br />the last stable <br />situation. <br />Step 5 Physical facilities <br />inspected for leaks. <br />Step 6 Dispenser meters <br />calibrated. <br />Step 7 Piping hydrostatically <br />tested. <br />Step 8 Underground storage <br />tanks precision tested. <br />Step 9 Additional investigation <br />as required by Shell <br />or the local agency. <br />This quarterly summary report <br />shall be submitted within 15 days <br />after the end of each quarter. Check <br />the quarter you are submitting <br />El Quarter 1 — January thru March <br />Submit by April 15 <br />Quarter 2 — April thru June <br />Submit by July 15 <br />El Quarter 3 — July thru September <br />Submit by October 15 <br />now -14111M <br />Send to (Local Agency):�S40t,-'-t, Z%4�AY <br />COPI THIS FORM FOR YOORDS <br />,1 <br />,//OEAL,tR SIGNATURE DATE <br />Explanation <br />OUT OF TOLERANCE <br />INVESTIGATIVE STEPS <br />Step I Review Records . <br />Step 2 New reconciliation <br />performed. <br />Step 3 Shell Oil notified. <br />Step 4 Records review from <br />the last stable <br />situation. <br />Step 5 Physical facilities <br />inspected for leaks. <br />Step 6 Dispenser meters <br />calibrated. <br />Step 7 Piping hydrostatically <br />tested. <br />Step 8 Underground storage <br />tanks precision tested. <br />Step 9 Additional investigation <br />as required by Shell <br />or the local agency. <br />This quarterly summary report <br />shall be submitted within 15 days <br />after the end of each quarter. Check <br />the quarter you are submitting <br />El Quarter 1 — January thru March <br />Submit by April 15 <br />Quarter 2 — April thru June <br />Submit by July 15 <br />El Quarter 3 — July thru September <br />Submit by October 15 <br />now -14111M <br />Send to (Local Agency):�S40t,-'-t, Z%4�AY <br />COPI THIS FORM FOR YOORDS <br />,1 <br />,//OEAL,tR SIGNATURE DATE <br />