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INVENTORY RECONCILIATION RECEIVED <br /> QUARTERLY SUMMARY REPORT FORM JUL 5 1991 <br /> ENVIRONMENTAL HEALTH <br /> Facility Hamas Tank f <br /> BRESHEARS CTIEVROucc <br /> Facility Addresst N_ PHONF• R' 'tS717"M23 <br /> 82 A" <br /> Telephone : WANCA CALIFORNIA 95836 C' L ✓ �— <br /> Person Filin <br /> >, <br /> Report <br /> PI hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limit, for this <br /> quarter. (No in Colum I]of the lovcotory 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 variatioo <br /> Ws not due to an unauthorized (leak) release. (Yes in Colin 17 of the <br /> Inventory Reconciliation Sheet) t <br /> List date, tank fa ant a nt for all variations that exceeded the <br /> allowable limits. <br /> Date Tank <br /> 1. <br /> a. <br /> 4. <br /> S. <br /> Additional dates/aaaouota •hall be contioucd on a separate Sheet of <br /> paper and attached. <br /> if the source of the variation which exceeded allowable li®its vas due to <br /> a leek the incident shall be reported to S .J _ L H . D . Environmental Ilcalth <br /> i <br /> wthin 24. hours and an unauthorrrcd rel a se report svb.ttted . <br /> ITe Quarterly auoaary report ■hall be sob..itted within IS days of the end of each <br /> Quarter. <br /> Quarter 1 - January --3 Marco, <br /> April -> Jwoc <br /> Quarter L - July --) septe.her <br /> QNar tr G - Octobcr --) ilecrmhcr <br /> Scnd co: SAN JOAQUIN LOCAL IIEA1.7li DISTRICT <br /> 1601 1i . I! Irt Il rum , I' -p . Ito, 'LUtl7 <br /> Stockton . CA '19201 466.67bI <br /> ul:r 40 10/H6 <br />