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INVENTORY RECONCILIATION VU <br /> QUARTERLY SUMMARY REPORT FORM x'1: 1 9 7198 v <br /> Facility Name: jOTO ��� � Tank 1 Size Product <br /> Facility Address: <br /> Telephone : s 2616 <br /> Person Filing <br /> Report STYE /<i�fE/t <br /> E] 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 an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date. tank f, and amount for 21L variations chat exceeded the <br /> Allowable limits. /?99/ <br /> Date Tank 1 Amount <br /> 1. 7-2c / '0f[ivF'?Y <br /> 2. 7- F,Aj <br /> 4. <br /> s. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation whichexceeded allowable limits was due to <br /> a 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 submitted within 15 days of the end of each <br /> quartcr. <br /> Quarter I - January --) Harch <br /> Qaarter 2 - April --> June <br /> Quarter 3 - July --> ieptcmhcr <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL Hl:AI.'fli UISTRIC'I <br /> 1601 E . 1lazellnn . P . O . Box 2009 <br /> Stockton . CA 95201 466 - 6761 <br /> UUT 40 10/86 <br /> +F <br />