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INVENTORY RECONCILIATION JAN 30 1387 <br /> QUARTERLY SUMMARY REPORT FORM ENVIROMENTAL HEALTH <br /> —FERMIT SERVICES <br /> Facility Name: _512 Tank t Size Product <br /> DOU eSr h <br /> Facility Address: /07/ A i' AIA) S6% iJA3T Di <br /> qInfl12Tee14 33C ira <br /> Telephone : vTj J'��cS iOG off) !, <br /> Person Fi ing <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 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 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank #, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. 1126 <br /> 2. / -i5 y f /wr <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 whiclh. ezceeded allowable limits �,zs due to <br /> it 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 DISTRICT <br /> 1601 E . Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-67b1 <br /> U(;T 40 10/ 86 <br />