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DUARTER1 INVENTORY -PORTING <br /> Facility Name: 'b&w S �N u� SL )I Tank# Size Product <br /> i <br /> Facility Address: ip- d <br /> city: <br /> Co `nty: ft`1�.L. � tj <br /> A <br /> State: <br /> 6-00 Waste Oi I <br /> hese were inventory variations that I hereby certify that all product level variations <br /> exceeded the allowable limits for this ❑ for the above mentioned facility were <br /> quarter. Q E C within allowable limits for this quarter. <br /> LIST DATE, TANK#AND AMOUNT`FORAW)VAPIATIONS OUT OF TOLERANCE <br /> THAT EXCEED THE ALLOWABLE LIMITS. INVESTIGATIVE STEPS <br /> Step 1 Review Records . <br /> Date Tank# Amount Explanation Step 2 New reconciliation <br /> '711-go _ performed. <br /> 1-7 + �/� Step 3 Shell Oil notified. <br /> Step 4 Records review from <br /> �Z - yoF�f��� -r,e�c,N 2nart the last stable <br /> situation. <br /> Step 5 Physical facilities <br /> 1-30 " S D �� inspected for leaks. <br /> 113 fl /25 Step 6 Dispenser meters <br /> Aqj calibrated. <br /> Ar 954 Step 7 Piping hydrostatically <br /> I tested. <br /> �a to CK- Step 8 Underground <br /> g wt's over P*I1nc nprSt- tanks precision tested. <br /> 7-I +2 _ IS4, Step 9 Additional investigation <br /> 10' 9 as required by Shell <br /> a or the local agency. <br /> 7.2s" — �obf This quarterly summary report <br /> -7 i +- Igo shall be submitted within 15 days <br /> after the end of each quarter. Check <br /> 7-3 /a20 the quarter you are submitting <br /> ❑ Quarter 1 — January thru March <br /> I Submit by April 15 <br /> Zuarter <br /> rter 2 — April thru June <br /> Submit by July 15 <br /> 3— July thru September <br /> Submit by October 15 <br /> 3 CP+ ❑ Quarter 4— October thru December <br /> // Submit by January 15 <br /> Send to (Local Agency): 04-A/ �a ."L�; I S <br /> o %t"d tz-7Th A' f(PBOX '�Wr <br /> KEEP COPIES OF THIS FORM FOR YOUR RECORDS <br /> DEALER SIGNATURE DATE <br />