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OUARTEROY INVE TORY*.PORTINGr <br />5�� <br />Facility Name: �i <br />Facility Address: 2315 illjt�I &A-T(ki h' <br />City: 1°1w <br />County: 5i*� Ji9Ac+��rJ <br />State: " <br />Tank # <br />Size <br />Product <br />Explanation <br />performed. <br />Step 3 <br />Shell Oil notified. <br />Step 4 <br />3 <br />I m <br />P-0 <br />Li <br />situation. <br />Step 9 <br />Additional investigation <br />iZ•� <br />..� <br />-2©S <br />or the local agency. <br />Waste Oil <br />These were inventory variations that JAN 2 3 19 I hereby certify that all product level variations <br />exceeded the allowable limits for the above mentioned facility were <br />quarter. NI,,ONMENTAI �LAJilhaallowable limits or thisquarter. <br />1iT/Sr"VS <br />LIST DATE, TANK # AND AMOUNT FOR ALL VARIATIONS <br />THAT EXCEED THE ALLOWABLE LIMITS. <br />Date <br />Tank # <br />Amount <br />Explanation <br />performed. <br />Step 3 <br />Shell Oil notified. <br />Step 4 <br />Records review from <br />Step 8 <br />the last stable <br />14, <br />situation. <br />Step 9 <br />Additional investigation <br />iZ•� <br />..� <br />-2©S <br />or the local agency. <br />i2�2� <br />3 <br />�ia`Z <br />(vZ9 <br />1 <br />Send to (Local Agency): <br />KEEP T I ORM FOR <br />DEALER SIGNATURE <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 />YOUR RECORDS <br />�-/ate-'Z- <br />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 />YOUR RECORDS <br />�-/ate-'Z- <br />DATE <br />