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fro <br /> I N V L N T 0 R Y R E C O N C I L E- T I ON' * <br /> QUARTERLY SUMMARY REPORT FORM <br /> JAN 8 ""'D <br /> ENVIRONMENTAL HEhLTH <br /> Facility Name: Diamond Walnut Growers , Inc Tank i SizqFl-"'VPibJ1kt <br /> O <br /> Facility Address: 1050 S. Diamond St . <br /> Stockton, CA 95205 <br /> Telephone: 209 467-6000 <br /> Person Filing <br /> Report: <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Column #13 of the Inventory Reconciliation Sheet.) <br /> ❑ Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (Yes in Column #13 of the <br /> Inventory Reconciliation Sheet.) <br /> List Date, Tank # and Amount for all variations that <br /> exceeded the allowable limits. <br /> Date Tank # Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a <br /> separate sheet of 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. Enviromental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> ❑ Quarter 1 - January --> March <br /> Q Quarter 2 - April --> June <br /> ❑ Quarter 3 - July --> September <br /> ®,Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON, P.O. BOX 2009 <br /> STOCKTON, CA 95201 <br /> CC : G. Carroll <br /> LR 3/88 C. Roth <br />