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QUARTERLY INVENTORY R -PORTING <br /> Facility Name: )0c, 7l S•��_j/ Tank �F Size Product <br /> Facility Address: 6-131 r<eel 141/6 <br /> City: <br /> County: a <br /> State: C� <br /> waste oil <br /> I hereby certify under penalty of perjury that all I ''o ct �'V'j ! " <br /> ❑ level variations for the above mentioned facility Wel– <br /> within <br /> el within allowable limits for this quarter. <br /> Inventory variations exceeded the allowable limits fWY 1 1989 <br /> this quarter. I hereby certify under penalty of perjury <br /> that the source for the variation was NOT due to ,r�;--N U L ri ;:. ;,I <br /> unauthorized (leak) release. <br /> PERMIR;SERVICES <br /> List date, tank f and amount for all variations <br /> that exceed the allowable limits <br /> Date Tank # Amount Date Tank f Amount <br /> C/-`S 7 <br /> Z- <br /> '3 <br /> -3 <br /> A--?— <br /> The quarterly summary report shall be submitted within 15 days <br /> of the end of each quarter. <br /> Quarter i – January thru March Submit by April 15 <br /> Quarter 2 – April thru .June 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 -5 J' <br />