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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> r SEP 231989 <br /> f.eility Name: prJ� �/�p�//�p� {�vpt) P/JI Tank f Sice Product <br /> r.ellity Address- mo <br /> �S <br /> Telephone <br /> Person Fill. <br /> Report / !J�t /10: 1u f <br /> hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Column 13of the Inventory Reconciliation Sheet) <br /> 0 Inventory Variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not dide to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List dater tack fr and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. <br /> 2. <br /> ]. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which exceeded allowable limits was due to <br /> a leak the incident shall be reported to 4; _J I, H Environmental Ilcalth <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March fs.x <br /> Q"arter 2 - April --> June to <br /> Quarter I - July --) %eptember 0 <br /> Q,,arter 4 - October --> IN-c.-ober 114 <br /> Send to: SAN JOAQU I N LOCAl. IIEAI.TG Ol :; l'It l l;'I' <br /> 1001 E . Hay.(• I l 4al . I' . O R" .. MWI <br /> 5lncktrnt , CA '0201 00' - Olhl <br /> 1ICT 40 I0/ 8h <br />