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r- <br /> QUARTERLf INVENTORY Rc 'l <br /> Facility Name: 41 -g eHV2l�-1*f�'/ Tank # Size VFW <br /> c <br /> Facility Address: X313 ell " T 12.., l� <br /> City: _-"TPz<re�?j 1"S2as <br /> County: _�4 1h=Lf/ A) <br /> State: r4td rt AJI fL <br /> Waste Oil <br /> These were inventory variations that I hereby certify that all product level variations <br /> ❑ exceeded the allowable limits for this ❑ for the above mentioned facility were <br /> quarter. within allowable limits for this quarter. <br /> LIST DATE, TANK#AND AMOUNT FOR ALL VARIATIONS OUT OF TOLERANCE <br /> THAT EXCEED THE ALLOWABLE LIMITS. INVESTIGATIVE STEPS <br /> Date Tank # Amount Explanation Step 1 Review Records .Step <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 uarter you are submitting <br /> IBJ Quarter 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):4<,,P,,y r,14/ -- <br /> P in <br /> KEFP COPIES OF THIS FORM FOR YOUR RECORDS <br /> DEALER SIGNATURE DATE <br />