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e <br /> OCT 211937 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM ENVIRONMENTALPERMIT/SERVICES LTH <br /> VICES <br /> Facility Name: TED PETERS TRUCKING Tank i Size Product <br /> 1 1000 FAL <br /> Facility Address: fMI41TICA, CA 95336 <br /> Telephone : 239 4949 117 <br /> Person Filing <br /> Report PETE VANDER POEL <br /> QI 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 /> 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) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> Gist date, tank i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/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 Ilcalch <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be rubmiCted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN 1.0CA1, HEA1,11i DIS-IRICT <br /> IbOI E . Hazc lion , P .O . hi)x 2UW1 <br /> Stockton , CA 95201 40G-67b1 <br /> lIC"1' 40 111/ 86 <br />