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INVENTORY RECONCILIATIuli <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Jac&not <br /> Tank E Size <br /> Produc <br /> Facility;Address: 4 ,n t n <br /> `—Lodi_ r' nS�rn - 4j.Z n p m U L <br /> Telephone : �, to oro U L Re ulz <br /> Person Filing �Q} 'Fo_SFc, <br /> Report Joe Sanzo <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> he above mentioned facility were within the allowable Limits for this <br /> quarter. (Ho in Column 13 of the inventory Reconciliation Sheet) <br /> L"1 Inventory variaciona exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> W-18 ooc due to an unauthorized (leak) release. (X1C7F74C <br /> }?R]CR�RxgX7�7t70)OlCXX7E xX10AXbA7cA1C3 (Based on daily measurement error�only.) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank R Amount <br /> 1. <br /> 2. <br /> ]. <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 which. exceeded allowable limits vas due to <br /> a leak the incident shall be reported Co <br /> Within 14 hours and an unauthorized release report D b sumiCCeidConxneal licalth <br /> The quarterly summary report shall be submitted within IS days of the and of each <br /> quarter. <br /> Quarter I - January --) March <br /> QQsartcr 1 - April --> June <br /> Quarter J - July --) Septcmhcr <br /> Quarter 4 - October --) <br /> December <br /> S<nd co: SAN JOAQUIN LOCAL. HEALTH DIS'1'RICI' <br /> 1 160L E . HaZC1Lon , P .O . Box 2009 <br /> UdT 40 LO/KG Stockton , CA 95201 466 -67bL <br />