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INVENTORY RECONCILIATION JUL 8 1991 <br /> QUARTERLY SUMMARY REPORT Fo�WIRONMENTAL HEALT' <br /> PFRMIT/SERVICES <br /> Facility. Name: f �� r ^ C Tank Size. Product <br /> F4cilityzAddress: <br /> Telephone : <br /> Person Filin <br /> Deport <br /> Q ; hcrcby,certify under penalty of perjurythat all invento <br /> w ry variations for <br /> the above oaentioned facility were within the allowable lilaits for this <br /> quarter. (uo in Column 13of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable, limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> 'as not due to an unauthorized (leak) releise. (Yes in Column 13 of the <br /> Iaveatory Reconciliation Sheet)' <br /> .List date, tank 1, and amount for all variatioas that exceeded the <br /> allowable limits. <br /> Date Tank I Amount , <br /> 1. <br /> Z. . <br /> 3. <br /> 4. <br /> 5. <br /> Additional .dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> Ef the source -of the variation which. exc•ecded 31-lovable Limits was due to <br /> at leak the incident shall, be reported to S ,J ,L.H . D. Environmental Lica l th <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be ,submitted viChin 15 days of the end of each <br /> quarter. <br /> Quarter I - January --} March <br /> iartcr 2 April --> .lune <br /> Quarter 3 - July --> Septemh(;r <br /> CNartcc 4 -- October --} ff eccmbcr <br /> Send to: SAN JOAQUIN LOCAL 1JEALTH DISTRICT <br /> 1601 E . Ha/C i l cm , P .O . Box 2009 <br /> 5uockton , CA 95201 466-6781 <br /> T 140 10/86 <br /> r <br />