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INVENTORY RECONCILIATION <br /> QUARTERLY SUKKARY REPORT FORM <br /> Facility K&ascZ8 R,Clr>.dt,s Tank t <br /> 4-($ Size Product <br /> PHONE: 823- #331123 <br /> Facility Addras�q, 5717 <br /> WANT_ <br /> Telephone : 1-1 . t---- 3 6'— <br /> Person FilingV <br /> Report <br /> [ hereby certify trader penalty of perjury that all inventory variations for <br /> the above memeioned facility were within the allowable Limits for this <br /> quarter. (Ko is Colum 13of the Inventory Reconciliation Sheet) <br /> ❑ Loventory variatioas exceeded the allowable Limits for this quarter. I <br /> hereby certify tinder penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) celease. (Yes in Column 13 of the ' <br /> Inventory Reconciliation Sheet) r <br /> Gist date, tank tr and amount for all variscioos chat exceeded the <br /> allowable Limits. <br /> Date Tank / Amount <br /> z. im <br /> 3. JUL 0 6 '390 <br /> 4 :NWRONMENTAL HEA! TF-I <br /> s. <br /> PERMIT/SERVICES <br /> AddlCiooal dates(aaoovots •hall be contioucd oo a separate sheet of <br /> ozper and attached. <br /> [ C the source of ehe variation which rxCecdcd alluuable limits vas duc to <br /> • lcsk the (nesdcn( shall be reported to <br /> $ .J . 1. H . D . Environ ntal health <br /> v[Chrn 24 hours and an unaatho n eed release report submit(ed. <br /> the Quarterly a. . .. report shall be •.abmitted vithin 15 days of the end of each <br /> Qu.rt'r . <br /> Quarter 1 - January <br /> Q•u rtcr 2 - April --) Jun'- <br /> Quarter ) - July __) icp[eml..•r <br /> Q1aartr 4 - October --) Il�crmhcr <br /> Send to: SAN JOAQUIN 10('AI. II1:A1.1'1i D11'1'HICT <br /> 1601 E . 1: 17.c11rn1 , P .O . Ilo %1111') <br /> 4(1 ID/K6 til OrkCon , CA 75201 466-67bl <br /> Uta' <br /> - Y <br />