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'QUAR�RP1( INVENTORY *.PORTING <br />Facility Name:Nu� <br />Facility Address: ��� L'� ✓r�' i!' <br />City: `�► rr <br />c^ <br />County: <br />State: <br />r° <br />_�TKese were inventory varnatl�ris `that <br />& ercaeded the allowable limits fgpris <br />quarter. f ISM <br />Tank # <br />Size <br />Product <br />Explanation <br />CSO <br />S2. <br />performed. <br />l - 2 �j <br />of <br />•– i 5 <br />Records review from <br />�-a <br />-- 132. <br />situation. <br />Step 5 <br />Physical facilities <br />inspected for leaks. <br />Step 6 <br />Dispenser meters <br />Waste Oil <br />I hereby certify that all product level variations <br />❑ for the above mentioned facility were <br />within allowable limits for this quarter. <br />ENV)RONW <br />PEl N",} 1 , <br />LIST DATE, TANK # AND AMOUNT FOR ACL VARIATIONS <br />THAT EXCEED THE ALLOWABLE LIMITS. <br />Date <br />Tank # <br />Amount <br />Explanation <br />Step 2 <br />New reconciliation <br />performed. <br />l - 2 �j <br />of <br />•– i 5 <br />Records review from <br />3 <br />-- 132. <br />situation. <br />Step 5 <br />Physical facilities <br />inspected for leaks. <br />Step 6 <br />Dispenser meters <br />calibrated. <br />Step 7 <br />c4f <br />f3c-- <br />r r rr <br />Step, 8 <br />Underground storage <br />.. /47 <br />a ,r <br />Step 9 <br />Additional investigation <br />as required by Shell <br />or the local agency. <br />12.10/7 <br />14 2 <br />2 <br />Irtb�,u <br />S' d II <br />3- 5'T <br />'T z <br />o <br />v fcC <br />i K ' h hay <br />OUT OF TOLERANCE <br />INVESTIGATIVE STEPS <br />Step 1 <br />Review Records. <br />Step 2 <br />New reconciliation <br />performed. <br />Step 3 <br />Shell Oil notified. <br />Step 4 <br />Records review from <br />the last stable <br />situation. <br />Step 5 <br />Physical facilities <br />inspected for leaks. <br />Step 6 <br />Dispenser meters <br />calibrated. <br />Step 7 <br />Piping hydrostatically <br />tested. <br />Step, 8 <br />Underground storage <br />OFYh0 , , <br />tanks precision tested. <br />Step 9 <br />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 />t <br />hearter you are submitting <br />arter 1 — January thru March <br />Submit by April 15 <br />❑ Quarter 2 — April thru June <br />Submit by July 15 <br />❑ Quarter 3 — July thru September <br />Submit by October 15 <br />❑ Quarter 4 —October thru December <br />Submit by January 15 <br />Send to (Local Agency): RA -AJ <br />Z% C9 t ft�rr J.� <br />KEEP COPIES OF,THIS FORM FOR YOUR RECORDS <br />ATURE DATE <br />