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QUARTERL INVENTORY R PORTING <br /> L <br /> Facility Name: ��� ��'�-- �'1 e 1 1 I Tank # Size Product <br /> Facility Address: co PQ 4(c' V P j <br /> City: . ' l.' <br /> County: ` -)q V �JoQ Y1�� C7�1 <br /> State: ��. 1 t T�r 1'1 1 <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 /> 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 /> en <br /> tested. <br /> Step 8 Underground storage <br /> ;-NM0NMENTAj HL41tanks precision tested. <br /> Lc.f SPR0"ES 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 /> LJ 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): �`n �Doa U i lrl <br /> r n 2-ol <br /> KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br /> Com( /( j/Lr DEALER SIGNATURE DATE <br />