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I`19 r ' <br /> INVENTORY RECONCiL1AilOr.,. <br /> QUARTERLY SUMMARY REPORT FORK J UL 1 7 1991 <br /> L. ENVIRONMENTAL HEALTH <br /> Facility Name; �� /� PERMIT/SERVICES <br /> Tank f Size Product <br /> Facility Address: �0� 7�1OT�2f�i1 G. <br /> GG' <br /> Te 1e hone : <br /> Person Filing <br /> °eport <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 Colrma 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, and amount for all variat <br /> allowable limits. ions that exceeded the <br /> Date Tank / Amount <br /> is — Awt-"' � <br /> 3. <br /> PAah <br /> 4. <br /> S.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 suomary report shall be submitted within 15 days of the end of each <br /> quarter- <br /> --Quarter_. I Janu_a_ry---> March <br /> Qarter 2 - April --> June <br /> e <br /> December Quarter 4 - October --) <br /> Send to; SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Hazelton , P .O . Box 2009 <br /> UCT 40 10/86 Stockton, CA 95201 466-6781 <br />