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QUARTERLY INVENTORYa <br /> REPORTING <br /> Facility Name: 00-c I Ae- SGp // Tank * Size Product <br /> � U <br /> Facility Address: -L131 e,-1 <br /> City: __Sfr2Ck7e11 3 Oa <br /> County: <br /> State: <br /> Waste Oil <br /> aI hereby certify under penalty of perjury that all product <br /> level variations for the above mentioned facility were <br /> within allowable limits for this quarter. f ;',y: <br /> n Inventory variation,, exceeded the allowable limits for y' 4 ` <br /> APR <br /> this quarter. I hereby certify under penalty of pery%fb" G� <br /> that the source for the variation was NOT due to an PFR , T�NTgC / <br /> unauthorized (leek) release. <br /> List date, _taW t Jenamo t or all variations <br /> that exceed the allowable limits <br /> Oate Tank f Amount Date Tank t Amount <br /> - � > <br /> i <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 15 <br /> Quarter 2 - April thru Juno submit by July 15 <br /> Quarter 3 - July thru September — Submit by October 15 <br /> Quarter 4 - October thru December - Submit by Janaury 15 <br /> Send TO (Local Agency) : <br /> KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br /> DATE MAILED -�/- le�,- �� <br />