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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Far_iliC] Name; �. � f/�+..�1 . e_ Tank f Sirc €'roduct <br /> �rcility -Address, 4�"lJi�fh <br /> Telephone : _ <br /> Person Fil <br /> ReportG <br /> s <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> V� the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Colum= 13of thz Laventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable limits for this. quarter. Y <br /> hereby certify under penalty of perjury that the source for"the variation <br /> was not due to an unauthorized (leak) relcaAe. (Yes in Columm 13 of the <br /> Inventory Reconciliation Shect) <br /> List date, tank f, aad amount for all variations that exceeded the <br /> Allowable limits. <br /> Date Tank f Amount <br /> I, <br /> 4. <br /> S, <br /> Additional dates/amouat3 ahatl be continued on a separarc altcet of <br /> paper 2nd attached. <br /> if the source of the variation which. exceede-d 9llouable limit--; was due. to <br /> A leak the incident shall be rcpnr(cd to S _1 . J_ H D . Environmental Health <br /> within 24 hours and an unauElio rirr_d release rrport submitted. <br /> The q«arterly sum-n-ary report shall he submitted virl, in 15 days of r-I,r rid of each <br /> quart rr. <br /> Quarccr I - January <br /> Qtiaarccr 2 - April <br /> Quarccr l - July --> scP(ember <br /> Quarter 4 - Occober --> R crmber <br /> Senri to: SAN JOAQU IN 1.()(-,Al, 11EAl.TH <br /> 1,601 1" . 11aze 1 t r,st , P . 0 . ft" 1()(lr) <br /> St ()c-kLon , (.n 95201 1400 - 67b1 <br /> 40 1r) / 80 <br />