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INVENTORY RECONCILIATION 0 <br /> QUARTERLY SUMMARY REPORT FORM �NV1R0tqAL �_th HEAL-TO <br /> � <br /> ;LT Name:GQN CONTI TRUCKING INC. Tank # Size ~Product <br /> Facility Address: 2660 LOOMIS RD STKN 95205 l I0 <br /> 0 <br /> Telephone : 209 948-5901 <br /> Person Filing <br /> Report DON GOODRICH <br /> L hereby certify under penalty of perjury <br /> the above mentioned facility were thintheaallowablet all ely�ryavfarafyzo�s for <br /> quarter. (No in Column 13 of the laveatoey Recoaciliseion Sheet) is <br /> Iovtutory variations exceeded the allowable limits for this quarter. Z <br /> hereby certify under Penalty of perjury that the source for the variation <br /> was act due to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Lmveatory Reconciliation Sheet) <br /> List date, tack #, and amount for 211 variations that exceeded the <br /> allowable limits. <br /> Date Tank # Amount <br /> 1. <br /> 2. <br /> 4. <br /> 5. <br /> Additional date%/araouan <br /> paper and attached. ts shall be cc, <br /> paper <br /> on segaraEe sheet of <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. Eavironmental llcalth <br /> within 24 hours aad an unauthorized release report submitted. <br /> The quarterly suamary report shall be xubmitted within I5 days of the end of each <br /> quarter. <br /> Quarter I - .January --) ?larch <br /> Q►sarter 2 - April __) June <br /> Quarte July --> Septcmhi-r <br /> r er 4 Octobcr --) [kcrmbcr <br /> Send to: SAN JOAQUIN LOCAL HEALTH DIS'I'H iC'I' <br /> 1601 E. Hazelton . 11 .0 . no x 2()()o <br /> 11t;1' 40 110/86 Stockton , CA 95201 466-6761 <br />