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OtA-RTERLY <br />P^ Facility Name: <br />Facility Address: <br />City: <br />a"Ji <br />variationsINVIRONMENTAL <br />These were inventory <br />xceeded the allowable limits for this <br />/�Oq <br />AMOUNTLIST CAM TANK # AND •, - ALL VARIATIONS <br />r . THE ALLOWABLE <br />04 <br />Dt` <br />Waste Oil <br />t f y certify that all product level variations <br />r the above mentioned facility were <br />within allowable limits for this quarter. <br />OUT OF • _. <br />INVESTIGATIVE <br />step I Review Records - <br />Step 2 New reconciliation <br />Step 3 Shell Oil notified. <br />_. 4 Records review from <br />the last stable <br />Stop 5 Physical facilities <br />inspected for <br />Step 6 Dispenser - <br />.sPiping hydrostatically <br />tested, <br />step a Underground storage <br />tanks precision tested. <br />Step <br />Additiorial investigation <br />as required Shell <br />or local <br />This quarterly summary report <br />shall be submitted within IS days <br />after the i of each quarter. Check <br />'the quarter yousubmitting <br />■January thru March <br />Submit . A <br />1 <br />September <br />submit by October <br />E3 Quarter 4 — October thru December <br />Submit by <br />Send to(Local. • <br />COPIES OF THIS FORM FOR YOUR RECORDS <br />