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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM III���'lllAAA"`v(((J V a <br /> Facility Name: �, jtlG/ti,/ tijod �/JT Tank 1 Size Product <br /> ,'acs pM <br /> ENTA <br /> Facility Address: ?Q7/ ER ICESIH <br /> nvnf <br /> n <br /> Telephone : 2D <br /> Person Filing <br /> Report //.v k. <br /> 0 1 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 /> 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 oat due to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List dater tack /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank 1 Amount <br /> I. <br /> 2. <br /> ]. <br /> 4. <br /> 5. <br /> Additional dates/amouots 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 ..1 . L . H . D . Environmental Health <br /> Within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days o[ the end of each <br /> quarter . <br /> Quarter I - January --) march <br /> Q,iarter 2 - April --> June <br /> Quarter ) - July --) September 0 <br /> Quarter 4 October --) tke.•mber l% <br /> Send to: SAN JOAQl1IN LOCAL HEA1.1-ii D I STT I C I' <br /> 1001 li . Haze l I nn , P 0 14„>: /1)m1 <br /> Stockt-on . CA '1'0201 10,11 - 0 /bl <br /> ir• 140 10/ 80 <br />