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INVENTORY RECONCILIATION JPi=uvxllll <br /> QU'ARTERLY SUMMARY RF-PORT FORM <br /> Facility N„,C; 7 APR 171989 <br /> Tank f <br /> Size <br /> Ftcility•Addreaa; <br /> y ; <br /> Telephone : rr2oj 1 aDp . <br /> Person <br /> F i 114,1 <br /> Report //n,»�/' O./ <br /> Ed L herebyY� <br /> terrify under penalty of Perjury that all inventory variations for <br /> Che above mentioned facility were within the allowable limits for this <br /> quarter- (Ho in Column 13of the loveotory Reconciliation Sheet) <br /> ❑ Loventory variations exceeded the allowable limits for this quarter. L <br /> hereby certify under Pcoalty of Perjury that Che source for the ver. Cion <br /> was oo[ due to as unauthorized (leak) releaae. (Y <br /> Leventory Reconciliation Sheet) e■ in Column IJ of the <br /> List date, [auk and amount <br /> allowable limits.. for all varia[ioas [hat exceeded the <br /> Date Tank / <br /> Amount <br /> 3. <br /> 4. <br /> Additional daces/amounts "All be contiaued oo a separate sheet of <br /> Paper and attached_ <br /> If the source of the variation which. exceeded allowable limits was due to <br /> • leak the incident shall be reported to S .J . L.H . D . Eovironmcntal Health <br /> Within 24 hours and an unauthorized release report submitted. <br /> quarter. <br /> The quarterly su assn ry rc Po rt :hall be submitted within 15 days of the end of each <br /> Quarter 1 _ <br /> January --) Na rch <br /> Quarter 2 - April __) June <br /> Quarter 1 - July <br /> Qu rtcr 4 _ Dcpc <br /> OC(ObCf --) DC CCmbebCr <br /> Send Co: SAN JOAQUIN 1.0CA1. HEALT)i DIS'1'HiCT <br /> 1601 E . Haze I t cul , P .O . Ilox 1009 4 <br /> 40 l0/HG Stockton , CA 95101 460 -G1bl <br />