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� o <br /> INVENTORY RECONCILIATION JAN 191989 <br /> QUARTERLY SUMMARY REPORT FORM ENViieONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> Facility Name: T Tank E Size Product <br /> 1 fQ 0OO 0Ca <br /> Facility Address: Sao E "w,4 )A a. ao � <br /> q"40 3 -oat - S (pl c <br /> Telephone : 00-a� 461-13x1 <br /> Person Filing <br /> Report sa,r.d� 4-f <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 /> QInventory 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) releise. (Yes in column 13 of the <br /> Inventory Reconciliation Sheet) - <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount ECEWED <br /> 1. <br /> 2. JAIL 1 . 1989 <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amount: shall be continued on a separate sheet of <br /> p_per 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 . Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be submiCted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> Jeptember <br /> 4QuArter 4 - October --> Drcetnbcr '91 <br /> Send to: SAN JOAQUIN 1-0CA1. HEALTIi UISTHLCI' <br /> 160 L E . H.17e 11 On . 1' . 0 . 1iox 2009 <br /> St-ockton , CA 95201 460 -67bL <br /> L11;T 40 10/ 86 <br />