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QUARTERP1( INVENTORY REPORTING <br />Facility Name: <br />Facility Address: <br />City: <br />i <br />County: <br />State: C A <br />JUL 19 "x'11 <br />Tank # <br />Size <br />Product <br />Explanation <br />Step 4 <br />Records review from <br />(-2- <br />situation. <br />Step 5 <br />CIL" <br />inspected for leaks. <br />Step 6 <br />Dispenser meters <br />calibrated. <br />Step 7 <br />Piping hydrostatically <br />tested. <br />Step 8 <br />Waste Oil <br />These were inventory variationiNIVMONMENTALWEAI reby certify that all product level variations <br />exceeded the allowable limits for ttftRMIT/SERVI or the above mentioned facility were <br />quarter. 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 />Step 4 <br />Records review from <br />12 <br />situation. <br />Step 5 <br />ct uC <br />inspected for leaks. <br />Step 6 <br />Dispenser meters <br />calibrated. <br />Step 7 <br />Piping hydrostatically <br />tested. <br />Step 8 <br />--�A k� � r� �. � r.; . ,Asa ;, -�, � . 'vJ• � <br />tanks precision tested. <br />Step 9 <br />Additional investigation <br />as required by Shell <br />or the local agency. <br />OUT OF TOLERANCE <br />INVESTIGATIVE STEPS <br />Step 1 Review Records. <br />Step 2 New reconciliation <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 />E. 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): , ' �or, u.'"' _N\4 <br />Iw � G. Nr:,zi✓1-�o.� <br />�S:Zo l <br />KEEP COPIES O�F/ITHIS FORM FOR YOUR RECORDS <br />DEALER SIGNATURE 14 -.1 <br />DATE <br />performed. <br />Step 3 <br />Shell Oil notified. <br />Step 4 <br />Records review from <br />the last stable <br />situation. <br />Step 5 <br />Physical facilities <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 />E. 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): , ' �or, u.'"' _N\4 <br />Iw � G. Nr:,zi✓1-�o.� <br />�S:Zo l <br />KEEP COPIES O�F/ITHIS FORM FOR YOUR RECORDS <br />DEALER SIGNATURE 14 -.1 <br />DATE <br />