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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> SOUTH COUNTY FOOD&FUEL CO. rank Site Prouoct <br /> raeiLity NA-et <br /> Minims c <br /> raeilie Addraut POST OFFICE BOX 516 <br /> Telephone: <br /> Person Filing \ �� <br /> Report }fir aiciR I�1 <br /> ElL hereby certify under penalty of perjury that all inventory variations for <br /> �_ • .r_ _ ._ within the alLovsble Limits for this <br /> the above mentioned ._ci•.zi -=re <br /> quarter. (No in colu� ;of the inventory Reconciliation Sheet) <br /> lavcntocy variations exceeded the allowable limits for this quarter. <br /> hereby certify under penalty of prjury that the source for the variation <br /> yes is Column I3 of the <br /> vas act due to an unauthorized (leak) release. ( <br /> Inventory Reconciliation Sheet) <br /> List date. tank /r and aaavot for all variations chat exceeded the <br /> allowable limits. - � <br /> Date yank Mount <br /> 2. <br /> 3. <br /> 4 <br /> Additional daces/amou ots shall be continued oa a separate sheet of <br /> paper and attached. <br /> hich. exceeded al <br /> e to <br /> Lf the source of the variation w 'l ovable u <br /> EovironmentalHealth <br /> a leak the incident shall be reported co S .J .L.H.D. <br /> within 24 hours sad an unauchorixed release report submitted. <br /> the Quarterly sua,a<ary report shall be submitted within 15 days of the end of each <br /> Q.arter. .�. <br /> Quarter I - January March <br /> Q,aareer 2 - April --> June ' <br /> Quarter 3 - July --> Sepcen,her <br /> Quarter 4 - October December <br /> Send co-_ SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HazclLlui , P .O . 11ox 2009 SJ /GCS APR 061992 <br /> Stockton . CA 95201 466-6761 <br /> UCT 40 10/ 86 <br /> -'k <br />