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r <br /> INVENTORY RECONCILIATION OCT <br /> QUARTERLY SRMMART REPORT FORM i:iVVu^<Oi1?J`t IT l I 1EALTH <br /> P!RMI l I SERVICES <br /> f F"Uty Mast: QE HlNUFRcTyeiA/�, Took It iter <br /> Produet <br /> facility Addrtteat �g,ZSE Cdl4frek k1.4 iErFL <br /> Telephone: _ 210 <br /> Person Filing <br /> Report rev <br /> ❑ I hereby certify under penalty of perjury that all inventory variations for <br /> the above mcociomed 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 Hader penalty of perjury that the source for the variation <br /> was not due to as unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) r <br /> Last date. task f. and amount for all variation■ that exceeded the <br /> allowable Limits. <br /> Date Tack I Amount <br /> 4. <br /> s. <br /> Additional dates/aaouots shall be contioued on a separate sheet of <br /> paper and attached_ <br /> If the source of the variation ..h,ch racecded allowable limits was duc to <br /> • leak the incident shall be reported In <br /> within 24 hours and an un.autlwr.crd relcasr report l submactedonase Environmental IlCal(h <br /> The Quarterly a-u mma ry report shall be aabmit(cd within IS days of the end of each <br /> Quartrr . <br /> Quarter I - Janu.ry --) n.,rcl, <br /> Q•aarter 2 - April --> JU..e <br /> Quarter ) - July --> icptcmher <br /> Quarter 4 - occober --> Ikcrmber <br /> Send to: SAN JOAQUIry 104:Al. IICAI.11i DINTHIC1' <br /> 1601 E. I!�r.t• Ilrtn , 1' .0 I)or 2gt17 <br /> 4U IQ/MG Stockton . CA 95201 406-67bl <br /> IN;T <br />