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k'. Z <br /> INVENTORY. RECONCILIATION APR 3 0 1992 <br /> QUARTERLY SUMMARY REPORT FORM L04" <br /> Facility Name: Resve-> <br /> - Tank A size Product <br /> 00C <br /> Facility Address: o%f9s"Z ;/P ?P <br /> 7 7,44 ark-/zn. -I F' <br /> Telephone: (zos) gsi- ziAA <br /> Person Filin� <br /> Report: s von„ e M�hey <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. (F2 in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> [ ( Inventory variations exceeded the allowable limits for this <br /> quarter. T. hereby certify, under penalty of per ury 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 /> I >iEse.J ,t .9✓ r� feeue� <br /> 3 , 89a 99L des e/ - Slo.o v eR4Ke. <br /> Cn'��lion d1uP <br /> 4 , - zl9z , zm i 2JiFsel SJ.J qv s fr�e�tu2e <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 /> Garter 1 - January---------->March <br /> Quarter 2 - pril ----------->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 />