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OYENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Tank f Size coduct <br /> Facility Address: d <br /> Z691/W <br /> Telephone : <br /> 606 <br /> Person F ling p <br /> Report <br /> E] 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 Column 13 of the lnvencory Reconciliation Sheet) <br /> _ y <br /> Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> van not due to an unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limics. <br /> Date Tank f Amount <br /> 1. <br /> � � p� APR 1 G fns^ <br /> 2. �2�' L ENV/RO,�::,, <br /> 3. pcr 7... <br /> Rlsi, �. <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 . Environmcncal licalch <br /> within 24 hours aad an unauthorized release report submieted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter- <br /> Qu:.rter 1 — January --> March <br /> Q•iarccr 2 — April --> June ' <br /> Quarccr 1=Ju Cy--- - --->--SeYrce�u bcr <br /> Quarter 4 — October --> December <br /> Send cc : SAN nQUI .r. iAt <br /> 1601 E. Haze1lrul . P .O . Rox 2009 <br /> $Lockcon • CA 95201 460 -67bl <br /> LIGT 40 10/ 80 <br />