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Ir (TORY RECONCILIATION - <br /> QUARTERLY SUMMARY REPORT FORM <br /> 41 , Tank« Size Product <br /> Facility Name : <br /> el m/>ti <br /> Facility Address: <br /> A777//7C <br /> Telephone: <Z 3) 3"3 - % 3 (- <br /> Person Filing • tj �Fte 2 z_ <br /> Report: <br /> 0 L hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the alLowable Limits for this <br /> tuaeter. (No in Colum 13of the Inventory Reconciliation Sheet) <br /> T <br /> 0 Inventory variatibas exceeded the allowable limits for this quarter. <br /> hereby earthly under penalty of perjury that the source for the variation JAN 14 1992 <br /> was not due to an unauthorized (leak) releiae. (Yes in Cotu■w 13 of the <br /> NEALT`i <br /> Inventory Rscoaciliatioa Sheet) PERM IT/SERViGE5 <br /> List data, tank it and annual for all variations that excceded the <br /> allowable liwiea. noun <br /> Date Tank N <br /> 3 <br /> 5. 16 - <br /> /' ' d / To 257 <br /> W <br /> 7. t�,o37 <br /> 207 <br /> 10. <br /> 1 <br /> . 3 7 <br /> 11 — <br /> 112.2. / -- # 3 <br /> 13. / <br /> 14. -/GLi- <br /> 1-5. <br /> 16. F5' 1 <br /> 17. Z-,O- E;t--- <br /> /C <br /> 20. . . . . <br /> 22.x_ _ - to 7V .. <br /> V <br /> 23. 272-7-& — - 77 -f-o f T-77 <br /> 24._x_ <br /> 26. <br /> 27 <br /> 28. <br /> 29._•x_ <br /> 30.E_ <br /> 31. <br /> Additionai date■is.a.:�ts =hall ti "nrip„ed on i separate ahaat oL <br /> paper and attached. <br /> to <br /> LC the source of the variation which. exceeded al'lowableElnviroonts me^CaluHealth <br /> a task the incident shall be reported to S,J .L.H.D. <br /> within 24 hours and an unauthorized relcase report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the and of each <br /> quarter. <br /> Quarter 1 - January March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - Occober --> December <br /> SAN JOAQUIN LOCAL HEALTH UIS'l'It1CT <br /> 1601 E. Ilazel"111 , l' .0 . 11ox 2009 <br /> Stockton , CA 95201 466-6761 <br />