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J U L 2 3 pan <br />INVENTORY RECONCILIATION FNVIRONMENTALHEP,LIH <br />QUARTERLY SUMMARY RffORT FORM <br />PERMIT/SERVICES <br />�7 <br />FaciliCy Nux���PL'y—�C� 1 �Llli&C� <br />iaeilicy Addresa: Lj�S�Ci(i(/ �Clt7 <br />Telephone: < <br />Person Filing <br />Reporc <br />�L hereby terrify under penalty of perjury Char all inventory variation - <br />the about a.enCioncd f+ciliry were wi[hin Chc allowable Bait■ for Chis <br />quarter. (No in COlu. 13of [hc lvvcn[ocy Reconciliation Sheet) <br />QInventory variations exceeded the aLlovable limits for this quarter, <br />bereby certify under penalty of perjury that the source for the variat <br />vis not due Co an unauchocized (leak) relcaae. (Yet in Cold 13 of the <br />Inventory Reconciliation Shccr) <br />Lint date, Caok 1, and amounC for all variations that exceeded C <br />allowable LimL'Ca. <br />Date Tank ! Amouar <br />0 <br />m <br />Additional daCes/amouoc5 chall be conCioued oo a aeparaCc aheeC <br />paper and aCtachcd. <br />LE Chc 30UCCC of Chc variaCion ..hich exceeded allowable limits was duc <br />a le■k Chc incident shall be reported to S.Q.L.H.D, EnvironacnCal 1 <br />WLChln 24 hours and an unauthorized release reporC submiC[ed_ <br />The quarterly summary report shall be Rubmittcd .+(Chin 1$ days of the end <br />quarter_ <br />