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INVENTORY RECONCILtATION APR 171999 <br /> QUARTERLY SUMMARY REPORT FORM <br /> ENVIi20NP✓tENTAi. Fit?ALTFI <br /> PERPAIT /SERVICES <br /> Facility Name: Jackpot Tank E Size Product <br /> n <br /> Faeiliey,Addcess: _ q01 g_ OhL ep Tnna 4 u r <br /> 4'l 1 00 prem U <br /> Lodi_ CA 9524n 41L <br /> '2 i0 000 U L Re u <br /> Telephone : X7091 3(q_SF 54 <br /> lar <br /> Person Filing <br /> Report Joe Sanzo <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 IJ 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, f(� XX)4RX4I41'F}i q 'Xtq� glgg <br /> �TRX74X«I4XaiX$�t7C14IC7L)LAC7[I4RX$AR3EF3� (Based on daily measurement erYor only.) <br /> List date. tank 1, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank I Amount <br /> 1. SEE ATTACHED INVENTORY CONRTOL SHEET <br /> 2. ASTFR SKS DFNOTF VARTATTnuc Ferppn NG ALLOWABLE LIMITS. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> Paper and actached- <br /> If the source of Che variation vhich. erceeded allowable limits was due to <br /> a leak the incident shall be reported to S ,J . L.H . D . Environ ntal health <br /> within 24 hours and an unauthorized release report submitted. <br /> Thequarterly sumaary report shall be submitted within 15 days of the end of each <br /> quartcr. <br /> Quarter I — January --) March <br /> Qaartcr 2 — April --> June <br /> Quarter ) — July --> Sepcembcr <br /> Quartcr 4 — October --) Dkccmbcr <br /> Send to: SAID JOAQUIN LOCAL HEALIH OIS'VIUCT <br /> 1601 E . Hazeltoui , P . O . Box 2007 <br /> Uc;T 40 10/86 Stockton , CA 75201 466 -6781 <br />