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QUARTE* INVENTORY PORTING <br />Facility Name: <br />Facility Address. <br />Shy: t 1 TIO -1-1 HN&_� <br />_72,1 -2-0 N • l.ID0Q_A'o <br />City- '�)}�e,L4„,j , &y '::�i SZU14 <br />County. <br />J . W <br />State: �' 1► P'v.,,,'� <br />APR 15 <br />Tank # <br />Size <br />Product <br />Explanation <br />Step 4 <br />Records review from <br />�' <br />i �• 0 <br />Kls u� A ^,. <br />3 <br />12u>> <br />u30 <br />inspected for leaks. <br />Step 6 <br />Dispenser meters <br />2 - <br />calibrated. <br />-k w S Z <br />Piping hydrostatically <br />tested. <br />Step 8 <br />Waste Oil <br />,�,�These were inventory variations that LAVIROf'I l�I I�,m�j ” ' )c r��,t �fy that all product level variations <br />I]d exceeded the allowable limits for this r��Mll'tSif,.c� r''1bde mentioned facility were <br />quarter. �nittlllowable limits for this quarter. <br />q <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 />the last stable <br />situation. <br />Step 5 <br />Physical facilities <br />inspected for leaks. <br />Step 6 <br />Dispenser meters <br />2 - <br />calibrated. <br />-k w S Z <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 />3- S <br />-yZi <br />SAh.c, As A6,/i, <br />j — I j <br />{ lV�l <br />►��� }JiGQj1k�C,G <br />3- Iq <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 />❑ 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): L-er%� N%At+`' 01'A <br />KEEP COPIES OF 7ORM FOR YOUR RECORDS <br />921. <br />DEALER SIGNATURE 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 />❑ 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): L-er%� N%At+`' 01'A <br />KEEP COPIES OF 7ORM FOR YOUR RECORDS <br />921. <br />DEALER SIGNATURE DATE <br />