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QUARTEF#Y INVENTORY PORTING <br />Facility Name: 1�!,��- <br />Facility Address: <br />1'3 -2,,> N. 61z�si-n, �. .) <br />City: <br />County. A�. v °'" ► <br />State: CAI.��cUv►A <br />1 <br />Tank # <br />Size <br />Product <br />Explanation <br />IZ u» <br />SU 'Lug-� <br />� \ Z_ <br />iZ UJB <br />Step 4 <br />3 <br />►L vJ� <br />2��J <br />situation. <br />Step 9 <br />a <br />it -CL. <br />as required by Shell <br />A <br />or the local agency. <br />Z3 <br />Waste Oi l <br />These were inventory variations that P �r�? V �Al kI reby certify that all product level variations <br />El exceeded the allowable limits for this �T fg' th+e;i4bove mentioned facility were <br />quarter. °ii0in 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 />lv-Z.t <br />J <br />� \ Z_ <br />\ <br />t►A�l: J�l.� I�CI,JN <br />Step 4 <br />Records review from <br />Step 8 <br />the last stable <br />situation. <br />Step 9 <br />a <br />it -CL. <br />as required by Shell <br />A <br />or the local agency. <br />Z3 <br />Q�r A ku <br />N04 M% -k cA' <br />t4�t��^� <br />-A <br />q qu <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 />Send to (Local Agency): C!NAu y%(&A al- 01 -Ni <br />t6o i <br />6. NAZG l 400 <br />5 4 c�. gSLo I <br />KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br />DEALER SIGNATURE 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 />Send to (Local Agency): C!NAu y%(&A al- 01 -Ni <br />t6o i <br />6. NAZG l 400 <br />5 4 c�. gSLo I <br />KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br />DEALER SIGNATURE DATE <br />