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QUARTERY INVENTORY tPORTING <br />Facility Name: Sly ti Hp.L4- <br />Facility Address: <br />City. <br />County: SQa Sonc�,i,.a <br />State: <br />Tank # <br />Size <br />Product <br />Date <br />tZ\ <br />Ru Z.00� <br />Lk 2,9 <br />3 <br />�\z\ <br />suZ0, <br />zo <br />/3u/eg <br />t <br />Waste all <br />F]I hereby certify under penalty of perjury that all product <br />level variations for the above mentioned facility were <br />within allowable limits for this quarter. <br />Inventory variations exceeded the allowable limits for OCT 1 !,9 19 <br />eg <br />F1 this quarter. I hereby certify under penalty of perjury <br />that the source for the variation was NOT due to an <br />unauthorized (leak) release. ENVIMNMENTAL HEALTH <br />PERMIT/SEW CE'S <br />List date, tank # and amount for all variations <br />that exceed the allowable limits <br />Date <br />Tank # <br />Amount <br />Date <br />Tank # <br />Amount <br />zo <br />/3u/eg <br />t <br />\off <br />189 <br />r1 %1'a h3-1 <br />2- <br />- \03 <br />1 iq /-�9 <br />- \ 0S <br />--k/a0 <br />~13 <br />The quarterly summary report shall be submitted within 15 days <br />of the end of each quarter. <br />Quarter i - January thru March Submit by April 15 <br />Quarter 2 - April thru June Submit by July 15 <br />Quar er 3 - July thru September Submit by October 15 <br />guar er A - October thru December - Submit by Janaury 15 <br />Send To (Local Agency)- SAS 7S0aqL&'N Lue-a\ <br />\6U\ �- �1aZtl koa \�.y.x ZUyS <br />amuck -Ear, �. 13%S2o1 <br />KEEP COPIES OF THIS FORM FOR YOUR OWN RECORDS <br />DATE MAILED K) - t \ - � <br />