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INVENTORY RECONCILIATION <br />.zRTERLY SUMMARY REPORT F <br />Lawrence Livermore <br />Facility Name: National Laboratory <br />Facility Address: P.O. Box 808, L-633 <br />Livermore, Ca 94550 <br />Telephone: ( 5,10) 423-1152 <br />Person Filing <br />Report: Wilfred E. Montemayor <br />Inn"k y c; .7o v.-Fav,.-+- <br />879-G1U1 <br />1 10,000 <br />Gal <br />I Regular <br />Gas <br />879-G2U1 <br />1 10,000 <br />Gal <br />Unleaded <br />Gas <br />I hereby certify under penalty of perjury that all inventory <br />variations for the above mentioned facility were within the <br />allowable limits for this quarter. (No in column 13 of the <br />Inventory Reconciliation Sheet.) <br />Inventory variations exceeded the allowable limits for this <br />quarter. I hereby certify under penalty of perjury that the <br />source for the variation was not due to authorized (leak) <br />release. (Yes in Column 13 of the Inven gr Reconciliation <br />Sheet). <br />( To the best of my Knowledge <br />List date, tank #, amoun ar o s e reason <br />for exceeding the allowabl 'li s. <br />Date <br />Tank <br />1. (SEE ATTACHED TABLE 1) <br />2. <br />3. <br />4. <br />5. <br />Amount <br />Reason <br />Additional dates/amounts shall be continued on a separate <br />sheet of paper and attached. <br />If the source of the variation which exceeded allowable limits <br />was due to a leak, the incident shall be reported to Public <br />Health Services of San Joaquin County Environmental Health <br />Division, within twenty-four (24) hours and an unauthorized <br />release report submitted. <br />The quarterly summary report shall be submitted within fifteen (15) days of <br />the end of each quarter. Circle appropriate quarter. <br />Quarter 1 - January ---------- >March <br />Quarter 2 - April ----------->June <br />Quarter 3 - July ------------>September <br />Quarter 4 - October ---------> ece ey <br />Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />1601 E. Hazelton Ave., P.O. Box 2009 <br />Stockton, CA 95201 <br />(209) 468-3420 <br />