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INVENTORY RECONCILIATION INS <br />/ QUARTERLY SUMMARY REPORT FORM APR 15 1991 <br />Facility Name: ICHN TAY' OR Ferro-1W7=6K6 Tank uct <br />r r•, <br />OFSTOCKTON <br />Facility Address: _ 2 vrBOX 6998 <br />ST5206 2 <br />Telephone: - <br />Person Filing <br />Report: 4y <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. QLoo 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 ,#, <br />for exceeding the <br />Date <br />2. <br />3.3/!/y0 <br />4. <br />5. 5Z41 Z:? -a <br />amount for all variations and the reason <br />allowable limits. <br />Tank Amount <br />Reason <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 quarterly summary report shall be submitted within fifteen (15) days of <br />the end of each quarter. Circle appropriate quarter. <br />Quarter 1 - January ---------- >March <br />Quarter 2 - April ----------->June <br />Quarter 3 - July ------------>September <br />Quarter 4 - October --------->December <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 />(209) 468-3420 <br />