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' c 2 1998 <br /> INVENTORY RECONCILIATION S�P <br /> QUARTERLY SUMMARY REPORT FORM EhVIRONM`ENTALHEALTH <br /> PERMIT I SERVICES <br /> Facility Name: � T Tank / <br /> Site Product <br /> Facility Address: /*o,4 -ty, /oma <br /> S_ror e!! 14 OA <br /> Telephone : 5463 :g1eG3 <br /> Person Fi("ng <br /> Report ,p„-"eae' YCY�.c e <br /> L 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 Columa I1 of the Inventory Reconciliation Sheet) <br /> ElInventory 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 to as unauthorized (leak) rel"se. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) - <br /> List date, tank /, and amount for 21L variations that exceeded the <br /> allowable limits_ <br /> Date Tank R Amount <br /> 1. <br /> i <br /> 2. <br /> 3- <br /> 4. <br /> S. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> Paper and attached. <br /> if the source of the variation which- exceeded allowable limits was due to <br /> a leak the incident shall be reported to S ,J .L. H . D. Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter 1 January --) March <br /> Qin rter 2 -� April --) June <br /> Quarterr) - July --> Septemher <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEAL1'1i DISTRICT <br /> 1601 E . Hazelton , P .O . Ftox 2009 <br /> UCT 40 10/86 SLockLOn , CA 95201 466-6761 <br />