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INVENTORY RECONCILIATION APR 3 1991 <br /> QUARTERLY SUMMARY REPORT FORM ENVIRONMENTAL. HEALTH <br /> Facility, <br /> PERMIT/SERVICES <br /> Name: V <br /> L' r .1 t ►LlC Tank # Size. Produc <br /> Fj�flity;llddress; I I J` mut, 14a)C-1— , <br /> Telephone <br /> Person Filing <br /> Report _t�u;Iu �`F �r✓� � � <br /> ED"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 13 of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the all'ovable. 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 Coluam 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date* tank 1, and amount for all variations that exceeded the <br /> allovable litnits. <br /> Date Tank f Amount , <br /> 1. . <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> Additional ,datcs/amouota shall be- continued on ,a separate sheet of <br /> paper and attached. <br /> If the source .of the variation which. exceeded allowable limits was duc: to <br /> A leak the incident shall. be reported to S .J .L.H . D. Environmental licalth <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly sumraicy rc"rt shall be Fubmittcd within 15 days of the end of each <br /> quarter. <br /> Quarter I January --> Harch <br /> saner 2 -- April --> June <br /> Quarter 3 - Jaly --> Scntcmhc.r <br /> Quarter 4 - October --) ikrcember ";M - 73`�r=d� <br /> j <br /> to: <br /> SAN <br /> Send JOAQUIN I.0011L HEALTH UIS-1-luc-r �ry ��`n <br /> 1601 E . <br /> `Lockton , CA 95201466-6781 1!1,R <br /> T 40 10/86 .. - <br /> ',:.), a.�CAQUIN COUNTY <br /> F'UDLIC I`CALTH SERVICE <br />