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i, <br /> 4; <br /> 5 <br /> INYEHTORY RECONCILIATION O C r 1989 <br /> QUARTERLY SUMMARY REP-ORT FORM �� <br /> A L <br /> Facility. 'iL�\r 'T'ank t Size. Product <br /> Telephone : _ <br /> Person Filing <br /> Report c.�:E� - <br /> El1. 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 /> ElInventory variations exceeded the allovable. limita for thin quarter. X <br /> hereby certify under penalty of perjury that the source for the vari:Cion <br /> vas noC due to an unauthorized (leak) releise. (Yes in Colu= 13 of the <br /> Iaveatory Reconciliation Sheet) W <br /> List date, tank i, and amount for all variations that exceeded the <br /> allowable litnits. <br /> Date Yank f A=unt , <br /> 3. <br /> 4. <br /> 5. <br /> Additional ,datesjamounts shall be continued on a ecpsratc sheet of <br /> - p=per and attached. <br /> If the source .of the variation which. exceeded al-lovable limits was due to <br /> a leak the incident shall. be reported to S .J .L.H . D. Environmental llcalth <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly sumn�3ry rc"rt shall be aubmit[cd within 15 days o1 the end of each <br /> quarter. <br /> Quarter 1 - January --> Hirch <br /> Q¢iartcr 2 - April - _> June <br /> Quarte ] -- July --> Scptcmh(.r <br /> Quarter 4 October --> %-cember <br /> Send to: SAN JOAQUIt4 WCAL 1JEALTH DISTRICT <br /> 1601 E . Haze1Lml , P .O . Box 2001) <br /> 5Lockton " CA 95201 466-6781 <br /> iI 1. Ito 10/86 <br /> f <br /> r <br />