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• _.__.J r"+ N — 1 �� — g 9 ^• - R E F E T R 0 L E i <br /> .... ._ T �� 1 4 = <br /> Y'1 O Ci <br /> INVENTORY RECONCILIATION 1 <br /> QUARTERLY SUMMARY REPORT fORM <br /> Facility Name: aAnIKk E-X.)(Q1NLtF LJ Tank I Si:�a Product <br /> Facility Address& gBC)D 0,_rg,0AlrAr F ki) . <br /> MANTEC Ara Q <br /> Telephone ; 13Q - ,J7 1 'j -- <br /> Fersoa Filing <br /> Report 1- Q1oL 14r)L0 "LL <br /> I hereby certify under penalty of perjury that all inventory variatis+-s for <br /> the above menciooed facility were within the allowable limits for this <br /> gearcer. (No in Colum 19 of the Inventory 9sCOdcili4tie4 Sheet) <br /> Icventory variations exceeded the allowabla'limits for, this quarter. 1 <br /> bereby certify under penalty of perjury that the source for the variatioa <br /> we not due to as unauthorised (leak) release. (1cs io, Colusa 13 of the <br /> Iavaatory saacmeiliatioa Sleet) <br /> list datmt tank i0 and anouac for all variations that exceeded the <br /> allowable Baits. <br /> DateaI nk I imq—t <br /> ]. <br /> s . <br /> Additional dates/a.ouacs shall be continued on a separate shad of <br /> Pepsi; and 4ttacbed. <br /> If the source of the variation which exceeded allowable limits vas 4+re to <br /> a leak the incident shall be repoeted to S ,J .L.H.D . eavironeentil FUcalth <br /> Within 24 hours and as unauthorised release report submitted- <br /> The gtsrterly summary report shall be rubaitce4 within 15 days of the end of each <br /> • gYart4r. <br /> (quarter 1 - January --> larch <br /> Quartep 2 - April --> June <br /> Quarter ] - July --> Septcmbgr <br /> Quarter 4 - October --> December <br /> Send to, SAN JOAQUIN LOCAL. HEALTH DISTR;CT <br /> 1601 E. Hazelton , 11 .0 . Box '2009 <br /> Stockton , CA 95201 466-6781 <br /> UOT 40 10/86 <br />