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INVENTORY RE CONCILIATION RECEIVED <br /> QUARTERLY SUMMARY REPORT FORM OCT 2 6 1989 <br /> {-� ENVIRONMENTAL HEALTH <br /> FacilitT Nie: <br /> PERM IT/SERVII&ES <br /> Task f Size Product <br /> Pacility.Addresa: G/ / D � <br /> 72�-E')3-rt! may. SSD/ <br /> Telephone : <br /> Person Filing <br /> Report <br /> I hereby certify under ,penalty of perjury that al <br /> the a`uave rationed faciliey were within the allowable elim sntory ~forathiss for <br /> quarter. (Ho in column l3 of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable limits for thisquarter. - <br /> hereby certify under penalty of perjury that the source for the variation <br /> was riot due to an unauthorized (leak) releaae. (Yes is Col.== of the <br /> Laventory Reconciliation Sheec) <br /> List date, tack I, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank 0 !Amount <br /> 1. <br /> z. <br /> 4. <br /> 5. <br /> a bt enaCinued on a separate sheet of <br /> paper and attached, � <br /> If the source of the variation which. exceeded al•lowab[e limits was due to <br /> a leak the incident shall be reported t4 <br /> within 24 hours and $ ,J ,L.H , D, EnvEnvironmentalLica t th <br /> an unauthorized release report submitted. <br /> The quarterly summary report shall be submi <br /> quarter. tted within 15 days of the end of <br /> each <br /> Quarter I January __) March <br /> Q'1arter 2 - �uly �Arter <br /> [ --� Jun <br /> Quarter 3 - -- Ju4 - er __ cr <br /> send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HazeILo n . P -0 , Box 2009 <br /> XT 40 10/86 SLockton ,- CA 95.201 466-5781 <br />