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OUARTER& INVENTORY FtPORTING <br /> Facility Name: PA 0-1 U E- ' 514 2� Tank# Size Product <br /> J ? _ v <br /> Facility Address: Li i 3 PA I iZ o tW 3it O <br /> City: JTZ` C I �� p 0619 1006 u c_r� <br /> County: <br /> State: W E iD <br /> ! Waste Oil <br /> ° D I hereby certify that all product level variations <br /> hese were inventory variations thaAU G D 1 1 <br /> P(lexceeded the allowable limitsr,Ab NENTAL HL� ��'the above mentioned facility were <br /> quarter. T , _ �` I `ubithin allowable limits for this quarter. <br /> PER�,�11 I i;,EER ICES <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 /> yv V%/eUGr�f4T/D�tl Q performed. <br /> Step 3 Shell Oil notified. <br /> Step 4 Records review from <br /> the last stable <br /> situation. <br /> 9 00 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 /> IP <br /> C U tanks precision tested.4 11q, <br /> �S Step 9 Additional investigation <br /> as required by Shell <br /> ,S r —ho f— or the local agency. <br /> RZPLq0 6fXAj%jr This quarterly summary report <br /> Darshall be submitted within 15 days <br /> after the end of each quarter. Check <br /> , w,/ 1I& the quarter you are submitting <br /> Mao ❑ 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): <br /> �or 71-1" <br /> KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br /> <:�- /. "�z 7- 5-- 2� <br /> DEALER SIGNATURE DATE <br />