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"VEMORT REC011C I L IAT I OM <br /> QUARTERLY SUMMARY REPORT FORM <br /> r•eilicr Name: ���� \�z�c�l�, �. <br /> Tank I Site <br /> I•GWtIf "greens `9L�C� Product <br /> C'P.�-nuc, c,: Ck70 <br /> Telephone lCS�SI� 4 <br /> Person FLLLng <br /> Report <br /> I hereby eeccify under proal[ of - <br /> tba above .eaeiaaed facility acre withint'the aalLovablec all climitsntory fo vaciatioas for <br /> `waccer. (No to Colum 1301 the levencory ILCConC,l,&Cioa Sheet)r this <br /> Clieveacocy variatioas exceeded the allowable <br /> hereby eecei(y wader pcaalty of perlimits foe this quarter, t <br /> jury that the source (or the veriatioa <br /> eovas aoc due to a• unauthorized (leak) retease. (Y�s <br /> lovcory accoaciliscion Sheec) is Ca)t�n l) of the <br /> List data, took /s and amount <br /> allowable limits. for all variations [bat exceeded the <br /> I <br /> 0ace <br /> Took / Amount <br /> 1. <br /> I. <br /> S. <br /> Additional <br /> Paper anJ attacheeddates , <br /> .ouats shall ba eoncisued oo s separate sheet of <br /> L <br /> f CAC source of the w riation which CmCuedcd alluw limits <br /> blC limi <br /> a leak the inctJcnt shall be rcpur(CJ to du, to <br /> $ .J . 1. . {I , D, Enviro"muau4s 1 <br /> 1calch <br /> within 24 hour[ and an unauchorited release report subnitteJ. <br /> rly su..s,lrr report shall be submitted uichin IS days Of the end <br /> quarter. <br /> of C.1 C 11 <br /> Qlrarlrl 1 J_aousr <br /> r •-> n.0 ch <br /> Pult.:r April ..� <br /> lluarcer 1 _ J•'••1° <br /> Jul <br /> Q•tartrr L - 0etober ) September <br /> ,cr heC <br /> ") IArc r•m r <br /> ;cnd co; <br /> 1AIJ JQAQlllly LOCAL 11EAI.TH DISTRICT' <br /> 14111 E . 1lait lltul , P ,O , Box 2I111) <br /> 1 10/116 Stockton , CA 95201 1-66•b7bl I <br /> • I <br />