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ypsay�Ii <br /> INVENTORY RECONCILIATION JUN 19 1989 <br /> QUARTERLY SUMMARY REPORT FORM ENVIRONMENTAL HEALTH <br /> / / � l PERMIT/SERVICES <br /> Eatility Name; p U ,� OU l.I Tank I Size Product <br /> Facility Address; � t^cino.�l'� <br /> (�{0_ ; <br /> Telephone : <br /> Person Fig <br /> Report /4(e7w" r <br /> I 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 I]of the Inventory Reconciliation Sheet) <br /> Ieventory 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 due to an unauthorized (leak) release. (yes in Column 17 of the <br /> Inventory Reconciliation Sheet) <br /> List date. tack /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 2. <br /> J. <br /> 4. <br /> S. <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 S .J . L . H . D . 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 1 - January --) Harch <br /> Q•iarter 2 - April --) June <br /> Quarter ) - July __) September N <br /> Q'iarter 4 - October --) D'.C.rmher 1% <br /> Send to: SAN .l0AOUIN LOCAI. HEAI.7'G D1SIItIC1' <br /> 1001 IC . Nazellim . PA) h'' . 711111 <br /> S( nckton . CA '0201 / 01 _ 0 /bl <br /> 111:1 40 If)/ H(, <br />