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i 0 <br /> .01 <br /> INVENTORY RECONCILIATION �` JAN 31982 <br /> QUARTERLY SUMMARY REPORT FORM <br /> E--EVVIRJNMENTAI a -�. h <br /> f'E7RMIT I SERMPS <br /> Facility Name: SHAUGHNESSY CAR WASH Tank I Size Product <br /> 1 6 000 • Rc�r-r�:lar <br /> Facility Address; 6011 E. Mi�aPr Avenue 2 12 .000 Super Un] <br /> Stockton CA 95202 3 12 , 000 Req, U& <br /> Telephone . ( 209) 465-2542 <br /> Person Filing <br /> Reporc Lila iii ll.heimer <br /> J1 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 13of 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 0 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> l. <br /> z. <br /> 3. <br /> 4- <br /> 5. <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 . 11 . p . Environmentak 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 --) Harch <br /> Q•1arrcr 2 - Apri 1 --> Juror <br /> Quarter 1 - July - > ticptrm6cr <br /> Quarter 4 - October --) I3ccember <br /> Send to: SAN JOAQUIN LOCAL HErAs.TW DISTRICT <br /> 1601 K . H ze 1 I "n , P . O . Rox 2009 <br /> Stockton , CA 95101 466-6781 <br /> KT 40 10/86 <br />