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J PETRO <br /> APR I ; ;337 <br /> INVENTORY RECONCILIATION ENVIROMENTAL HEALTH <br /> QUARTERLY SUMMARY REPORT FORM FERMIT/SERVICES <br /> Facility Name: BILL M0BB0W'S SHELL Tank # size Product <br /> $23-5265 AjL <br /> Facility Address: 1 n7 Flo Main a SSO <br /> Montana (-A QSq.'tA U C P'9D <br /> Telephone : b' �-SaI� S UUvO Re Z. <br /> Person Filing <br /> Report ;00 ) 1- 96 <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 Colu® 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 f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank # Amount <br /> ----`-- <br /> 2. <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 whichexceeded 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 --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRT CT <br /> 1601 E . Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-67b1 <br /> UGT 40 10/ 86 <br />