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ECEIVE <br /> OENTORY RECONCILIATION JUL 3 1991 .. <br /> QUARTERLY SUMMARY REPORT FORVIRpNMETAL IE,A ,T <br /> ,t <br /> _ PERMIT/SERVICES <br /> Facility Nine: 1�i toC 7662 kT 6s Tank 1 Sixc - Pr duct <br /> P;cilitr�Jlddress' xfn7tl } ',e44 ,,J' Qz C� I <br /> a <br /> Telephone :; y <br /> Person Pilin <br /> Report cz, � s <br /> I 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 /> IRventocy variations exceeded the allowable limits for this quarter. ' Y <br /> hereby certify uodcr penalty of perjury that the source for the variation <br /> was not due to ao unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Rcconciiiation Sheet) • <br /> List date, tank I, and anwunt for all variations that exceeded the <br /> allowable limits. <br /> Date Tank 0 Amount <br /> r <br /> 2. - <br /> 77 <br /> 3. <br /> 4. <br /> 5. . <br /> Additional dares/amounts shall be continued an a separate sheet of <br /> paper and attached. ' <br /> If the source of the variation which. exceeded al-lowable limits was due to <br /> a leak the. incident shall be reported to S ,J ,L.H,p, Environmental Hea 1 th <br /> Within 24 hours and an unauthorized celease report submitted. <br /> arae quarterly summary report shall be submitted within IS days of the end of each <br /> quarter. <br /> Quarter 1 - January March <br /> quarter 3 - Jul►r --) Scpcewhcr <br /> %,c..rk.cr 4 - uctoocr Lccemue: <br /> Send cc: SAN JOAQUIN LOCAL HEALTH UISTHlCT <br /> 160L E. Hart l um , P .O . lacy 2009 <br /> Stockton . CA 95201 466-6761 <br /> .GT 40 10/ 96 <br />