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QUARTE&Y INVENTORY fEPORTING <br /> g -5 / Tank# Size Product <br /> Facility Name: PC,-c- r t c <br /> _ . / <br /> Facility Address: � t � p <br /> % cti< < A t 4 4� <br /> U <br /> City: <br /> County: <br /> State: <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 /> Step 1 Review Records . <br /> Date Tank# Amount Explanation Step 2 New reconciliation <br /> 3 - <br /> C99 cLd S r c performed. <br /> Step 3 Shell Oil notified. <br /> Step 4 Records review from <br /> — 7-L r r �� the last stable <br /> situation. <br /> Step 5 Physical facilities <br /> 19 t inspected for leaks. <br /> 3!2 �� 1 r 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 — 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): S� Jen e4 <br /> KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br /> DEALER SIGNATURE DATE <br />