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INVENTORY RECONCILIAT"rON <br /> QUARTERLY SUMMARY RFPORT FORM <br /> Facility Name: Jackpot Tank f Size <br /> Product <br /> FaeiliCy,Addre u; _401 rh 4 1 n PO u r <br /> . . L kPa T 4 O0 prem II L <br /> Lodi ('� 95�4n 412 10 000 rJ/L Re ular <br /> Telephone : (909) iF9_SF 4, <br /> Person Filing <br /> Report Joe Sanzo <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> Cbe above mentioned facility were within the allowable limits for this <br /> quarter. (Ho in Column 13of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was GOC due to An unauthorized (leak) release. (tXl:?iXT.RXftaR <br /> n' �R- XXR{7C74?11t7C71X7iSX1J}lXb�RitZ3� (Based on daily measurement error only.) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> FCZa1y%tSEFLATT_-A1CHED <br /> teTank E Amount <br /> INVENTORY CONRTOL SHEET <br /> (, Q - _ �GTEg12 DENOTE VAS1ATTnVC EQaEEn1N <br /> 'Jul- 1 � �,.t��3. .IG ALLOPABLE LI.fITS. <br /> ENVIROMENTAL HE4JH <br /> FERMIT/SERVICES <br /> S. <br /> Additional daces/amounts shall be continued on a separate sheet of <br /> Paper and attached. <br /> Lf the source of the variation which. exceeded allowable Limits was due to <br /> a leak the incident shall be reported to <br /> within 24 hours and an unauthorized release report sDubmittedonmencaL IlcaLth <br /> a e gccrterly summary report shall be Rubmitted within 15 days of the end of each <br /> Quarter I - January --) March <br /> Qiartcr 2 - April --) June <br /> Quarter 3 - July --) September <br /> Quarter 4 - Octobcr --) (kccmbcr <br /> to: SAN JOAQUIn LOCi11- HEAL1'li 01S'1'KIC1' <br /> 1601 E . HazclLon . 1' .0 . Iiox 20()9 <br /> SLockton . CA 95201 466 -6781 <br /> UCT 40 10/86 <br />