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0 0 FIEUW4 <br /> INVENTORY RECONCILIATION ,!A PJ cl 11989 • <br /> QUARTERLY SUIMARY REPORT PORN <br /> ENVIRONiMENIAL HEALTH <br /> PERMIT/SERVICES <br /> t!•cillty Naa•et Tank <br /> Sate Product <br /> tr fj, <br /> facility AddrealAAtz.c ruA�ronwr <br /> Telephone : 824 EAST YOSEMITE <br /> Person Fi11n IFOItNi 95336 <br /> Reporc� <br /> [ bereby 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 is Colum 13of the Inventory Reconciliation Sheet) <br /> El " ventory variations exceeded the allowable limits for tbis quarter_ I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to An unauthorized (leak) release. (yes in Column 13 of the } <br /> loveacory Reconciliation Sheet) I <br /> Gist date. tank f. and amount for all variations that exceeded the <br /> allowable liatits. <br /> Date Tank I Amouot <br /> 1. <br /> 2. <br /> 3. <br /> AddiCiooal dates/aa.owota shall be concieued as n -epararc shcct of <br /> paper and attached. <br /> If the source of the variation uhtch e.cecded alluwble limits as duc to <br /> • leak the incident shall be reported to S .J . L . H . D . Environmental Ilcalth <br /> within 24 hours and an unauthor,ud release report subaiCted. <br /> the Quarterly su"ry rc Port shall be submitted within IS days of the end of each <br /> Quarter , <br /> Quarter I - Janw.ry --) M.trclt <br /> Q'14uter 2 - April --> J.",- <br /> Quarter <br /> uneQuarter J - July --> �eptemhor <br /> Qvartr 4 - October --) Ucccmher <br /> Send to: SAN JOAQUlu LOCAL IIEAIJI; DISTRICT <br /> 1601 1: . I!ar.t Iltm , I .U . Hnx 2[111'1 <br /> Stockton , CA 95201 1.66-67bl <br /> U1:T 40 10/ 86 <br />