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- )2-902 <br /> INVENTORY RECONCILIATIO. <br /> N u SUMMARY REPORT FOA <br /> Facility Name: d'0041- /N,>Rt co l.4aor,LL Tank size . Product <br /> 150 SrL <br /> Facility Address: _ 6W -oadat )klduw <br /> Telephone: boy <br /> Person Fil 'ng <br /> Report: kQ G- F <br /> I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Inventory Reconciliation <br /> Sheet) . <br /> List date, tank 1, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank A Amount Reason <br /> 1. 170n <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5. <br /> Additional dates/amounts shall be continued on a separate <br /> Sheet of paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Services of San Joaquin County Environmental Health <br /> Division, within twenty-four (24) hours and an unauthorized <br /> release report submitted. <br /> The quar rly summary rWJlY <br /> be submitte withi fif en (15) days of <br /> the endo each uarterppropriate uarter. <br /> Quarter ----- -->March <br /> uarter ----- - -->June <br /> arter --- ---- >Sept berQu ter , - ------- a tuber <br /> Send to,: SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E. Hazelton Ave. , P.O. Box 2009 <br /> Stockton, CA 95201 <br /> A 21523 (209) 468-3420 <br />