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�� �. <br /> INVENTORY RECONCILIATION 1 <br /> QUARTERLY SUMMARY REPORT FORM r , _•, la'- iiccLTN <br /> Facility Name: Anheuser-Busch, Inc. Tank I Size Product <br /> 1 <br /> FaeilityWdress: 3932 Budweiser Court 2 6,000 oals, <br /> Stockton, California 95205 <br /> Telephone : (209) 931-5661 <br /> Person Filing <br /> Report Ron Meyer <br /> ©X 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. 0— io ro_,wmn I3of :e '_u- c_.[ary Recoccil:a[ian Sherd <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 due to an unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank t, and amount for all variations that exceeded the <br /> allowable limits. <br /> �.._y Date Tank / Amount <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts chap 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 Health <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 - Jaouary --) March <br /> Quarter 2 - April --> Juf�c <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December <br /> end CO: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Ha7Cil4111 , P .O . BOX 2009 <br /> Stockton, (.A 95201 460-6761 <br /> ;1' 40 10/80 <br />