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QUARTERPf INVENTORY PORTIN <br />Facility Name: <br />Facility Address- _Z S'2_ o A) - (2-A <br />City* <br />County, <br />State, <br />These were inventory variations that <br />�exceeded'•the allowable limits for this <br />quarter. <br />I here•y certify that all product level variations <br />■for the above mentioned facility were <br />within allowable limits for this quarter. <br />LIST DATE, TANK # AND AMOUNT FOR ALL VARIATIONS <br />THAT EXCEED THE ALLOWABLE LIMITS. <br />Date <br />Tank # <br />Amount <br />Explanation <br />3 <br />4Q-6 <br />W"4Li-_ <br />o­om'-A bAy. Ati wliz& <br />4 <br />CP Q_ A 600 C <br />t <br />All <br />_-A <br />–10--- <br />-2- <br />OUT OF TOLERANCE <br />INVESTIGATIVE STEPS <br />Step 1 Review Records. <br />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 />tested. <br />Step 8 Underground storage <br />tanks precision tested. <br />Step 9 Additional investigation <br />as required by Shell <br />orthelocalagency. <br />I <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 />LQuarter 2 — April thru June <br />Submit by July 15 <br />El 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): moo,") 06,04t, <br />cn, HAQ6H11_1"' <br />cr%. <br />KEEP COPIES OF <br />TIS FORM FOR YOUR RECORDS <br />DEALER SIGN A*REDATE <br />