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V <br /> 1\YII APR 3 0 1992 <br /> INVENTORY. RECONCILIATION FNVIR,,")"I .+N (AL �iFAL1H <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: k%�v S /,t,cf Tank 0 size Product <br /> Facility Address: i!Sa <br /> _S�n 27i� . C 95L�9 <br /> Telephone: (2o4) vs1-2i99 <br /> Person Filing <br /> Report: c�nF .^9� lFe <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. (NQ in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> C- f 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 f, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank I Amount Reason <br /> G mIrFf2.2 <br /> i3 /i F r u ' O.S l v ', ✓ , i cCP...If.,e�/{.2 /�/�92 <br /> 'COnT<I+LT/P� �Nf <br /> 2. '117 AZ- 1/319 re Ca,lale — �a S• ! H✓ ,•- •eu��.,ee <br /> 61 <br /> m.S ACad •'^E '�� <br /> 3 . -AIL-A.7 - 'ieP u /a. "lo(o•.5 l�✓ ecc�.,�� _°��;/�/9� <br /> 4 . <br /> 5. <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 /> Quarter1 - Januar---------------- >Mar <br /> Quarter-2 - April ----------->June <br /> Quarter 3 - July ------------>September <br /> Quarter 4 - Octok2er --------->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 />