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VV <br /> trv_Y: rR , k�CONCiIa;. . i0r. <br /> CT 1987 <br /> 171) QUARTERLY SUMMARY REPORT FORM ENVIROMENTAL HEALTH <br /> F ERM IT/SERVICES, <br /> Facility Name: Anheuser-Busch, Inc. Sank / Size Product <br /> 1 <br /> Facility Address: 3932 Budweiser Court 2 6,000 aals, Gasoline <br /> toe ton, a i ornia 95205 <br /> Telephone : (209) 931-5661 <br /> Person Filing <br /> Reporc 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. (No in colu® 13of the Inventory Reconciliation Sheet) <br /> EJInventory 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) releiae. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, and amount for all variations chat exceeded the <br /> allowable limits. <br /> ' Date Sank I Amount <br /> I. <br /> 2. <br /> 3. <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 S .J .L.H . D. Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> rhe Quarterly summary report shall be submitted uichin 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) HArch - <br /> Quarter 2 - April --) June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --) fkcember <br /> end to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160L E . I:37.C1L4w . P . O . Box 2009 <br /> Stockton , (.A 95201 460 -6761 <br /> T 110 10/ 80 <br />