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w. <br /> •NVENTORY RECONCILIATION JUL 191989 <br /> QUARTERLY SUMMARY REPORT FORM ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICE° <br /> Facility Name:! j,fa�j rs tiA1; Tank i Size Product <br /> Facility Addresez '�OE !` <br /> tr tP0 <br /> Telephone : -C K'15 <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 as 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 I Amount <br /> 1. . - I -F,q f 0 <br /> 2. LJ-1LlP9 Com) (JR5 LOf- � <br /> 3. <br /> 4, Cy ( Cxf1S READk�IGTA� wF1S STUCC, <br /> 5.. - ( L� STUCK R EAI�In6G TA E. <br /> Additional date*/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 klcalth <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 DISTRLCT <br /> 1601 E . Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> UGT 40 10/86 <br />