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UPCIVED <br /> - �-QUARTERLY INVENTORY REPORTtut81990 <br /> ENVIRONMENTAL HEALTH <br /> VICES <br /> Facility Name: Tank ! Size Product <br /> Facility Address: Floc- l yiF 4v p- <br /> City: 404- 3 oG I/ <br /> County: :4 � '�` S° <br /> State: <br /> �S�f? waste oil <br /> I hereby certify under penalty of perjury that all product <br /> level variations for the above mentioned facility were <br /> F within allowable limits for this quarter. <br /> Inventory variations exceeded the allowable limits for <br /> this quarter. I hereby certify under penalty of perjury <br /> u that the source for the variation was NOT due to an <br /> unauthorized (leak) release. <br /> List date. tank E and amount for all variations <br /> that exceed the allowable limits <br /> Date Tank # IYn Amount Date Tank f Amount <br /> 10-off- Over //.?S' / f q-2 t /m S <br /> /o- eve.- 167 9- 2o 23 '1-Z /2Z ."o5�1 <br /> 6"/ 3 4-, p <br /> i - /f <br /> c,- 1 87 <br /> aceto '1- <br /> /,/3 f z" 3V L <br /> - 0-33%2 4--2-s/ <br /> tatI <br /> �4- <br /> ® I b l a /So / // <br /> The quarterly summary report shall be submitted within 15 daysZ- <br /> of the end of each quarter. <br /> Quarter i — January thru March Submit by April 0 <br /> Quarter 2 — April thru June Submit by July 15 <br /> Quarter 3 — ,July thru September Submit by October 15 /--)mj;,Nder a P <br /> Quarter 4 — October thru December — Submit by Janaury 15 DQ e. rx, <br /> Send To (Local Agency) : ldo,m,-;1i Ar s i^ <br /> f E COPIES OF THIS FORM FOR YOUR OWN RECORDS <br /> D� MAILED <br />