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INVENTORY RECONCILIATION fur J ;o0o <br /> QUARTERLY SUMMARY REPORT FORM r;'A ONIViEWALHEALTH <br /> PERMIT/SERVICES <br /> Facility Name: Anheuser-Busch, Inc. Tank f Size <br /> Product <br /> Facility,'Addresa: 3932 Budweiser Court 2 <br /> toe ton, ai ornia 95205-1a / 00 a <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. (No in Column 13of the Inventory Reconciliatic <br /> ElInventory 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 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variatioas that exceeded the <br /> /// allowable limits. <br /> Date Tank f Amount <br /> 2. <br /> 3. <br /> 4_ <br /> • 5_ <br /> Additional dates/amouats 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 /> The Quarterly summary report shall be submitccd within 15 days of the end of each <br /> Quarter. <br /> Quarter 1 - January --) March <br /> Quarter 2 - April --> Junc <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --) lkcember <br /> �j end col SAN JOAQUIN LOCAL HEAL1'li UIS"1'KIC1' <br /> 1601 E. Hazelt(n) , P .O . li<is 2()()9 <br /> Stockton . CA 95201 466 -67bl <br /> 1 40 10/86 <br />