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/I INVENTORY RECONCILIATION <br /> jv APR 1 6 1992 <br /> g( <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: " Tank# Size Product <br /> Facility Address: <br /> Telephone: <br /> Person Filing <br /> report: �jC-� 1ief/�-Z-L <br /> 1 bereby certify under penalty of perjury that all inventory variations for <br /> the above mentiomsd facility were within the allowable limits for this <br /> %uarter. (Mo is column 13 of the inventory Reconciliation Sheet) <br /> Inventory variatibas exceeded the allowable limits for thio quarter. • t <br /> bereby certify under penalty of perjury that the source for the variation <br /> was sot due to an unauthorised (leak) release. (Yes in Column 13 of the <br /> laventory Reconciliation Sheet) <br /> List date. task P. and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank Amount <br /> 2:- <br /> 3. <br /> /// 4 . i iy / / — Z1/ t, fZ71 <br /> / 5 OJ. 2L 41 / - 335 f,, f311 <br /> Hti J <br /> 6:. <br /> 2�i ✓ s4 y - —�1> ; 'tom a 7C T <br /> 8. <br /> 9. <br /> 10. <br /> 11.E _ r f <br /> / 12. /,, .,. -7 y "L ,.74Li to 2V <br /> 13. /V // # —fiYG Cb 6{3 r1 <br /> 14. <br /> 15. <br /> 16. <br /> 17. <br /> 18. 7EiV / 3 2y 72 �. <br /> 19. <br /> ivi �� 20. <br /> 21. L" !� ? �d 1 �af'Zlf�i <br /> 22:74)"t- 3 — <br /> 23. <br /> 24. <br /> 25. <br /> 26. <br /> 27. <br /> 28. <br /> 29. . <br /> 30. <br /> 31. <br /> . <br /> Additional dates/amounts shall ba continued an a separate sheat of <br /> paper and attached. <br /> It the source of the variation uhich. exceedcd allowable limits was due to <br /> a leak the incident ahall be reported to S,J .L.H.D. Eavironmental Ucalth <br /> within 24 hours and an unauthorised release report submitted. <br /> 1Le quarterly summary report •hall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --> March <br /> Quarter 2 - April June <br /> Quarter I - July --> September <br /> Quarter 4 - October --> December <br /> Seed tet SAN JOAQUIN LOCAL HEALTH DIS'1'HICT <br /> 1601 E. Hazellim , 11 .0. Box 2009 <br /> Stockton , CA 95201 466-6761 <br /> ' 40 10/86 <br />