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QrUARTER( IN OORY FO.,PORTING <br />Facility Name:Tank # Size Product <br />Facility Address: �� ZS 76&,4' a <br />City: <br />County: c+ <br />T.g <br />c <br />State: <br />� <br />These were inventory variations thatJAN 2 3 1992 1 hereby certify that all product level variations <br />exceeded the allowable limits fir; his"Al# the above mentioned facility were <br />quarter. . Ir t.' +_ENTAL H LI i <br />��r�SER`dICES within allowable limits for this quarter. <br />�'Erti�� <br />LIST DATE, TANK # AND AMOUNT FOR ALL VARIATIONS <br />THAT EXCEED THE ALLOWABLE LIMITS. <br />Date <br />Tank # <br />Amount <br />1 <br />Rye <br />So <br />--9S <br />12OCO <br />Si =L— <br />'2- <br />-89 <br />the last stable <br />Ll <br />situation. <br />t lic <br />Additional investigation <br />as required by Shell <br />or the local agency. <br />IZ�ZZ <br />3 <br />+1 <br />Waste Oil <br />These were inventory variations thatJAN 2 3 1992 1 hereby certify that all product level variations <br />exceeded the allowable limits fir; his"Al# the above mentioned facility were <br />quarter. . Ir t.' +_ENTAL H LI i <br />��r�SER`dICES within allowable limits for this quarter. <br />�'Erti�� <br />LIST DATE, TANK # AND AMOUNT FOR ALL VARIATIONS <br />THAT EXCEED THE ALLOWABLE LIMITS. <br />Date <br />Tank # <br />Amount <br />Explanation <br />10 -t <br />performed. <br />--9S <br />Shell Oil notified. <br />I' -i <br />'2- <br />-89 <br />the last stable <br />situation. <br />t lic <br />Additional investigation <br />as required by Shell <br />or the local agency. <br />IZ�ZZ <br />3 <br />+1 <br />I Z 13 <br />-3 <br />`1d7 <br />12.-Z <br />3 <br />+�2 <br />12-30 <br />1l <br />Send to (Local Agency): <br />jai r / <br />DEALER SIGNATURE <br />OUT OF TOLERANCE <br />INVESTIGATIVE STEPS <br />Step 1 <br />Review Records . <br />Step 2 <br />New reconciliation <br />performed. <br />Step 3 <br />Shell Oil notified. <br />Step 4 <br />Records review from <br />Step 8 <br />the last stable <br />situation. <br />Step 5 Physical facilities <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 />YOUR RECORDS <br />r � - 16 - �' Z_ -- <br />DATE <br />inspected for leaks. <br />Step 6 <br />Dispenser meters <br />calibrated. <br />Step 7 <br />Piping hydrostatically <br />tested. <br />Step 8 <br />Underground storage <br />tanks precision tested. <br />Step 9 <br />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 />YOUR RECORDS <br />r � - 16 - �' Z_ -- <br />DATE <br />