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RECEIVErf <br /> INVENTORY RECONCILIATION JUL 16 1990 <br /> QUARTERL" SUMMARY REPORT FORM ENVIRONMENTAL HEALTH <br /> � PERMIT/SERVICES <br /> Facility Haase: 01X1(/,. �j� � MIS,Facility Address: Zck'Telephone : nog qy3- >& _PersonReport i " `YSSJ/O <br /> 1 hereby certify under penalty of perjury that . 11 inventory variations for <br /> the "bo-e wo,tioned facility wcze within the ci.lova 'le limits for this <br /> Quarter. (Ho ca Colum 13 of the Inventory Reconciliation Sheet) <br /> ElInventory variations excee:'cd the allovable Ji. its for this Quarter. I <br /> hereby certify uo 'er penalty of perjury that th source for the variation <br /> vas not due to ar, ut -;utharized (leak) releise. (Yes in Column 13 of the <br /> ' Inventory Reconciliation Sheec) <br /> List date, [ ak 1, and amount for all variations that exceeded the <br /> allowable limits. • <br /> Date Tank P Amount <br /> 1. <br /> 4. <br /> s. <br /> Additional dates/mounts chill be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which exceeded cello,:- ble limits was du( to <br /> a leak the incident shall be reported to S .J .L.H . D. <br /> within 24 hours and an unau(horizcd release report sub.iCtcdonmcn[al Itcalth <br /> the quarterly summary report shall be xuhmi(tcd -i(hin 15 days of the end of each <br /> qu-rter. <br /> Quarter 1 - Janunry --) Harch <br /> Qiarcer 2 - April --> Jun( <br /> �Quart, r ) <br /> - July __) Sct„ '-�hcr <br /> Q.ar[cr 4 - October --) 11k c -mhcr <br /> Scnd (o: SAN JOAQUlr+ LOCAL HEALTI; DISTIl ICF <br /> 1601 F . I!n'r.( It ut . I' .O . Itox 2U(17 <br /> Stockton . CA '15201 400 - 62bI <br /> jUCI 40 IO/ Hh <br />