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0 <br />i <br />+ DUARTEF?-Y INVENTORY REPORTING <br />Facility Name: /,,�� <br />Facility Address: may/ <br />City: <br />Caunty:c--57h //- 4441-C-5� <br />State: <br />Tank #1 <br />Size Product <br />Amount <br />Date <br />Tank <br />Amount <br />'�crr� Pse 1�P•v <br />—,146 <br />Waste Oil <br />I hereby certify under penalty of perjury that all product <br />Dlevel variations for the above mentioned facility were <br />within allowable limits for this quarter. <br />Inventory variations exceeded the allowable limits fo4R E C E I V E" 6? <br />this quarter. I hereby certify under penalty of perjury U L 1 8 iaQ <br />that the source for the variation was NOT due to an <br />unauthorized (leak) release. ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />List date. tank t and amount for all variations <br />that exceed the allowable limits <br />Date <br />Tank # <br />Amount <br />Date <br />Tank <br />Amount <br />—,146 <br />�f <br />1Z <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 Jana=7-we <br />Send To (Local Agency): <br />oo V, <br />0 c, -e <br />KEEP COPIES OF THIS <br />OWN RECOROS <br />DATE MAILED <br />/ `moi IM-- <br />