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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORK <br /> Facility Name: L(Z1J;�S ���r S2e T C�` Tank / Siee Product <br /> ( 2 Opo s e <br /> Facility Address: -Nu7 WlaLerv L4 n2.. (o r� � <br /> Telephone : �4 `�� 131 <br /> Person Filing <br /> Report ,�,Ps <br /> TTTE9 1 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 /> Iaventory 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 unauthorised (leak) release. (Yes in Column 13 of the <br /> lnveetory Reconciliation Sheet) <br /> List date, tack 11, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tack / Amount <br /> 1. <br /> 2. <br /> 4. <br /> S. <br /> AddiCiooal dates/amounts shall be continued on a separate aheet of <br /> paper and accachcd. <br /> If the source of the variation which excoeded allowable limits vas due to <br /> a leak the incidcn( shall be rcporced to S .J D . EnvironmcncaL Ilcalch <br /> within 24 hours and an unauchorited release report submitted. <br /> ITc quarterly summary report shall be Rubmi(ted within IS days of the end of cash <br /> q.,r(er. <br /> Quarr I - January __) u.. <br /> Quarter <br /> Ju...... <br /> Sepc <br /> r I - April --) <br /> Quarter ) - July --) cpCcmhcr U <br /> Quarter 4 - octobcr --) Il�ccmber <br /> FEB 4 f988 <br /> Send co: SAN JOAQUIN LOCAL HEAI,TIi DIS'IItIC'1' [- FAL <br /> 1601 1' . Hazel ( on . P .0 hox 2110) FERM1f; TERVFiEALTFT <br /> /SER <br /> Stockton , CA '15201 466 -67b1 <br /> ICES <br /> �,ua' 40 10/ 86 <br />