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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Horton's C.ac Marr Tank E Size Product <br /> 11/10 6,000 1 U/L Premium <br /> Facility,Address: 13475 N. Jacktone Rd. 715 10,000, U/L Regular <br /> E. Lodi. CA 95240 731 '12,000 Regular <br /> Telephone : (209) 368-71,65 <br /> Person Filing <br /> Reporc Joe Sanzo <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. (Ho in Colu® 13 of 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 not due to an unauthorized (leak) release. k3pt74}Lp3{ji�pgf {�yf <br /> i�vtfyyYpyw l�vw v�1%k�UppXkk7S74�� (Based on daily measurement error only.) <br /> List date. tank /, and amount for all variations chat exceeded the <br /> allowable limits_ <br /> Date Tank / Amount <br /> 1. SEE ATTACHED TNVENT02Y CONTunT. CN 7TS <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional daces/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 /> The Quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March <br /> QQiarter 2 - April --> June <br /> Quarter 3 - July --> SCPtcmhcr <br /> Quarter 4 - October --) December <br /> S<nd co: SAN JOAQUlN LOCAL HEALTE DISTRICT <br /> 160L E. HazclL<m , P .O . 130x 2009 <br /> SLOCkton . CA 95201 466 -6781 <br /> LILT 40 10/86 <br />