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-'INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> M AA210E_, Tank* Size Product <br /> Fac111ty <br /> Facility Addrea:s : � C�-/A c• � <br /> Telephone: <br /> C <br /> L :r 0-1 --� -- — <br /> Person Fili—ng (_- - <br /> Report: e vt 6 - Y! <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> the above wentioaed facility uere within the allowable limits for this <br /> quarter.. (Hs in Colum 13 of the luventory pocnnciliation :sheet) <br /> .J <br /> g <br /> reveatory variatibas exceeded the allawabla lime■ for this quartert <br /> hereby certify ander penalty of perjury that the source for the variation <br /> was not due to an unauthorised (lesk) release. (yen in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> t for all variations that. exceeded the <br /> List date. tank 1. sad &moun <br /> allowable lfrfca. Amount <br /> Date Tank <br /> u ,k { 2 hrw — �x-;511 . ' I 13L� 7 X314 <br /> 2. I� it, 3 a v 1 <br /> 3 <br /> 4 : <br /> Z7 o <br /> 6. A (Afo_ <br /> 7. 3.x _ <br /> 4-2 <br /> 10. <br /> at / <br /> 13.--1< -71 — <br /> 15. <br /> 16.��l_2�_- # — — <br /> 17. <br /> . <br /> 1 <br /> 9. <br /> 20. <br /> 21. <br /> — <br /> _ <br /> 22. <br /> 23. <br /> 24._ — - - <br /> 25. _ - -------- <br /> 26. <br /> 27 <br /> 28.x__ <br /> 29.___- _ <br /> 30. <br /> 31._ <br /> Additional date&/amounts shall be continued on a separate *heat of <br /> paper and attached. <br /> was <br /> e to <br /> If the source of 011. v :iatia+: ut,frte. ercr�e�al'lo°iD E vmironmentaluucatch <br /> a leak the incident shalt be ceparted to S.J .L.II .D. <br /> within 24 hours and an unauthorised release repart submitted. <br /> TM quarterly aumaaary r=port shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter 1 - January* --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> Septemhar <br /> Quarter 4 - octobcr --> occcmber <br /> Seed to: SAN JOAQUIN LOCAL HEALTH UIS-1•Hicr <br /> 1601 F. Haze)cull , 11 .0 . Ito,,. 20109 <br /> Srockron , CA 115201 466-6761 <br /> ,T 40 10/86 <br />