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4 <br /> INVENTORY RECONCILIATION APR 6 <br /> 1989 m <br /> QUARTERLY SUMMARY REPORT FORM <br /> E <br /> Facility Name: 4"S' Tank Size <br /> � <br /> Product <br /> duetPHON : w)" "-7[acility Addreaa�4 E TY823 823-5717 <br /> Car.IF()RNr — <br /> Telephone : 1�5 � —' <br /> Person F� r � ' V� <br /> Report pport ort , <br /> �j L hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were vithin the allowable limits for this <br /> quarter. (No in Colum 13of the Inventory Reconciliation Sheet) <br /> U inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas not due CO an uoauthorired (leak) release. (yes in Colum 13 of the <br /> loveotory Reeoaciliation Sheet) ( <br /> List date, tank /, and amownt for all variations that exceeded the <br /> allowable limits. <br /> Date Tank 1 Amount <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> Additiocal dates/amouats shall be continued on a separate sheet of <br /> Paper and attached. <br /> If the source of the vaciati.on which axcecdcd allow ble limits was due to <br /> . Leak the (nc(dcn( shall be reported (n S .J . 1. . 14 . D . Environmental Ilcal ( h <br /> withtn 24 hours and an unauthor,ted release rcport subait.ted. <br /> nac aw r(cr(y 'u. ar-y rcport shall be +..baitted within 15 days of the end of each <br /> Q..artcr . <br /> Quarter I - Janu.ry --) Marcl, <br /> QQAarter 2 - April --> J...w <br /> Quarter ) - July __) Jeptcmbcr <br /> Puftr 4 - Octobc_r --) lk-c.•mber <br /> Send to: SAN JOAQUIN LOCAI. IIEALTIi DISI'KICT <br /> 1601 tC . 1!azelltnl , 11 .0 . Bos lolly <br /> 10/ 1i6 Stockton , CA 95201 466-6761 <br /> Ula' G(1 <br />