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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: /ZOT27 aee'y 2 Tank i Size Product <br /> / to evv vyL f/rte£ <br /> Facility Address: 31/or-v fo, Z / vr� /JiFfEc <br /> Telephone : X65=26/6 <br /> Person Filing <br /> Report rre-� KIEL«2 <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable Limits for this Quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to so unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tack i, and amount for 211 variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. /� i2 / 6, z- Z i ?R�rr 2 <br /> 2. //—// / -7, <br /> 3. <br /> 4. /0- 77 <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached- <br /> If the source of the variation which exceeded allowable limits was due to <br /> ■ leak the incident shall be reported to S .J . L. H . D . Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be Fubmitced within 15 days of the end of cacti <br /> Quarter. <br /> Quarter I - January --) Harch <br /> Q,iarter 2 - April --> June <br /> Quarter 3 - July --> >cptcmhcr <br /> Quarter 4 - October --) fkccmber Send to: SAN JOAQUIN LOCAI. HEAL'I'li 01STRICf RICE \,y1601 F - Hareltqui . P . 0 . Box 2009 <br /> Stockton , CA 95201 466 -6781 FEB 101989 <br /> UC1 40 10/86 ENVIRONMENTAL HEALIH <br /> PERMIT/SERVICES <br /> ti <br />