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itEIVED <br /> INVENTORY RECONCILIATION JUL 18 1990 . <br /> rl`Jv'IRUI�iVItN iAL HEALTH <br /> QUARTERLY SUMMARY REPORT Ft3RMP`; '�,i!T/JERV E'S <br /> Facility Name: t.JaL� 1 Tank # Size Product <br /> 7= 1. 7ova <br /> Facility Address: (D 7 1n 7 E, 4000 <br /> r <br /> Telephone : 11&o4-3 <br /> Person Filing <br /> Report <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 /> Inventory variations exceeded the allowable limits for this 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 /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount ;for all variations that exceeded the <br /> allowable limits_ <br /> Date ?auk # Amount <br /> I- 9TJ 61190 Z - 17 <br /> 2. w T-1 L3 <br /> 3. <br /> 4. Fc) / -/ 7 <br /> 5. -r-17 <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 i - January March <br /> Quarter 2 - April --> .lune <br /> Quarter 3 - .July --•> September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1.601 E . Hazelton, P .O . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> UGT 40 10/86 <br />