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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facillt N ��.Y 7 <br /> // -- <br /> ;T.���'��. - Tank 0 Size <br /> Product <br /> FacW.t.y;Address: i! <br /> C' <br /> Telephone - <br /> Person <br /> e1ephone :Person Filing <br /> Report <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> Che above oention,d facility were within the allowable limits for this <br /> quarter. (Ho is Column 130f Che lavcatory Reconciliation Sheet) <br /> ❑ Inventory variations exceeded the allowable Limits for Chia quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) releise. (Y_es in Columasl3 of the <br /> Inventory Reconciliation Sheec) <br /> List date, tank /, and amount for all variations chat exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additioaal dates/amounts shall be contioued 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. Eavironmental llealch <br /> Within 24 hours and an unauthorized release report submitted. <br /> The quarterly aummary report shall be submitted within IS days of the end of each <br /> quarter_ <br /> Quarter I - January --) March <br /> Quarcer 2 - April --> June <br /> Quarter ) - JuLy -_> Sep[cmhcr <br /> Quarter 4 - October --) December <br /> Send cc: SAN JOAQUIN LOCA1. Ht;ALTli UIS'1'RIC'I' <br /> 160E E. l:arclt (m , 1' .0 . Ilox Z(l()9 <br /> Stockton , CA 95201 466-67b1 i <br /> u;1' 40 10/86 <br />