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1V <br />t 1.1k,•. <br />r � <br />1=17111117T Mill; 7-1 <br />rie <br />d=,, .., +., f , • <br />Of PftJurY that all of the im variations each month, for tits above mentioned facility and <br />year, wen within on allowsw aft limit. <br />OR, tF FACUrY IS ON <br />❑ 1 hereby certify Under PMW of perjury that all of the Statistical Inventory Reconciliation Reports, for the above mentioned <br />facility and year, most the roqwremeft Unft law, <br />t41 thea ate al Katat� s a Were filo <br />❑ Inventory vo (a) exceeded the allowable Kate limit as toted below. <br />OR, -#F FACILITY -16 ON SM: <br />❑ S ty R0000CM91011 Roport(s) did roti moot the retgtireMCM under state law as noted below. <br />AND, IF APPROPMATE. <br />❑ I hemby oeftify Undet penalty of petyttry that the mum for the variation(s), of Statistical Inventory Rcoonciliation Report(s) <br />which did not awe the rquiremenss under the state law, was not due to an unautborind release. <br />t month, tafNt number, and amount of variation for each month that the variation exceeded the allowable limit_ or the <br />an Rwon did not meet the r <br />Tank No. <br />1. <br />2. <br />3, <br />4. <br />6. <br />6. <br />Additional months shall be continued on a separate Sheet of paper and attached. <br />Amount of Variation <br />Note.' lythe source of the variation which exceeds California allowable limit,c was due to a leak, the inCident ,Mull bee reparted to the local <br />underground storage tank agency within twenty four (24) hours. An unauthorized Release Report shall be submittert within five (.5) days, <br />For stations tttili2ing Inventory Reconciliation lir Manual Tank Gauging, this report must be submitteed to the Inc al Underground Swrage T tnk <br />.Regulation Akenry on an annual basis. <br />IMCI- j <br />