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O <br /> UARTER�1( INVtORY W-PORTING <br /> I ) l 1 �/► �� `� I I T nk # Size Product <br /> Facility Name: i S` <br /> Facility Address: 1071 �nl . <br /> City: <br /> County: <br /> State: I� 2 — Waste Oil <br /> 4: <br /> -� " I hereby certify that all product level variations <br /> These were inventory variatioire� 1t '" ' for the above mentioned facility were <br /> ❑ exceeded the allowable lirrgK19r jhIR92 within allowable limits for this quarter. <br /> quarter. <br /> ��W92MRPIEN T AL HEALTH <br /> FtiJ I f /,,- :c;Er1, OUT OF TOLERANCE <br /> LIST DATE, TANK # AND AMOUNT FOR ALL VARIATIONS INVESTIGATIVE STEPS <br /> THAT EXCEED THE ALLOWABLE LIMITS. Step 1 Review Records . <br /> Date Tank # Amount Explanation 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 /> ❑ Quarter 1 — JanuaryMarc <br /> Submit by April 15 <br /> ❑ Quarter 2 — April thru June <br /> Submit by July 15 <br /> ❑ Quarter 3 — JSubthru mit byeOctober r15 <br /> In ❑ Quarter 4— October <br /> Submit tDecemberhru <br /> by January 15 <br /> Send to (Local Agency): 4F; �tA'� /IS <br /> ?��� <br /> 11�oi A E <br /> gATYA�m CA %410 I <br /> 4KECOPIES OF THIS FORM FOR YOUR REC RDS <br /> CA <br /> q <br /> DEALER SI NATURE DATE <br />