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QUARTERPY INVENTORY PORTING <br /> ���p � �� �� Tank # Size Product <br /> Facility Name. �a0O �C_ <br /> Facility Address: '320E V i F-�o� da G- <br /> City: G a d- 7z rb U <br /> County: 5A--AJ 7C,4&0., I a l d <br /> State: <br /> ' ..'ASO Waste all <br /> _ rJ <br /> I hereby certify under penalty of perjury that all prO434 lb( �+ <br /> level variations for the above Mentioned facility w <br /> F] <br /> within allowable limits for this quarter. o <br /> Inventory variations exceeded the allowable limits ford U L 19 1989 FUN <br /> this quarter. I hereby certify under penalty of perjury �► <br /> that the source for the variation was NOT due to anEN R .IENT��EALTH <br /> unauthorized (leak) release. <br /> List date, tank # and amount for all variations <br /> that exceed the allowable limits <br /> C • � <br /> Date Tank # Amount Date Tank Amount <br /> �! 3 .m : - f. -I I 14- <br /> 0 4- � ' y <br /> —/,0/ a -.e <br /> - S' - �t' /9 y L <br /> - — /3f, ¢ <br /> 71 3 <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 /> Quarter 3 - July thru September Submit by October 15 <br /> Quarter 4 - October thru December - Submit by Janaury 15 <br /> Send To (Local Agency): - <br /> KEEP COPIES OF THIS FORM FOR YOUR OWN RECOROS <br /> DATE MAILED <br />