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QUARTERL <br />Y INVENTORY <br />Fac i 1 ity Name: /</ � —51A <br />Facility Address: may/ & <br />City: G4 <br />County: <br />State: <br />I hereby certify under penalty of perjury that all product <br />F I <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 # and amount for all variations <br />that exceed the allowable limits <br />Date <br />Tank <br />Sit f}'� 7G <br />-PORT.° <br />4 <br />R <br />w, <br />p �y <br />fi iI� <br />i� Ei-, <br />E -, <br />ip <br />,, . <br />I hereby certify under penalty of perjury that all product <br />F I <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 # and amount for all variations <br />that exceed the allowable limits <br />Date <br />Tank <br />Amount <br />fv -1A <br />MM, <br />E -, <br />ip <br />_5- <br />,o <br />I hereby certify under penalty of perjury that all product <br />F I <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 # and amount for all variations <br />that exceed the allowable limits <br />Date <br />Tank <br />Amount <br />fv -1A <br />z- <br />ip <br />_5- <br />,o <br />? <br />Date <br />Tank <br />Amount <br />f 1, % <br />? <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 iS <br />Quarter 2 — April thru June Submit by July 15 <br />Quarter 3 — July thru September Submit by October 15 <br />Quarter A — October thru December — Submit by Janaury <br />Send To (Local Agency) : L <br />KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br />DATE MAILED �, <br />