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INVENTORY RECONCILIATION <br />0 <br />QUARTERLY SUMMARY REPORT FORM JAN 41989 <br />ENVIRONMENTAL HEALTH <br />LO) <br />PERMIT /SERVICES <br />!/v/,,,_�a.I <br />Facility Name. Q^k Jh—,(il,KLLA <br />Facility Address: i( <br />Telephone: /— L <br />Person Fili <br />Report <br />Tank i Size Product <br />d C� <br />U <br />E 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 Columa 13 of the inventory Reconciliation Sheet) <br />ElInventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury tha't the rource for the variation <br />was not due to ao unauthorised (leak) releise. (Y• -- in column 13 of the <br />Inventory Reconciliation Sheet) <br />I <br />List date, tank I, and amount for all varinc-oos that exceeded the <br />allowable lis,its. <br />Date Tank f Amount <br />2. <br />3_ <br />4. <br />5. <br />Additional dates/amounts &hall be continued on a separate sheet of <br />paper and attached. <br />Lf the source of the variation which exceeded alto able limits was due to <br />A leak the incident shall be reported to S . J . L . 11 . D. Environmental Health <br />within 24 hours and an unauthorized release report submitted. <br />The Quarterly summary report shall be rubmitted within 15 days of the end of cacti <br />Quarter. <br />Quarter I - January --) March <br />Q•4arcer 2 - April --> Jun! <br />Quarter ) - July --> Septcmhcr <br />Q%jarter 4 - October --) 0,-cember <br />Send CO: SAN JOAQU IN LOCAL HE:AL-1'1i DI STIt (-T <br />% <br />160L I:. Have l t (m . P .0 . Iic�x <br />Stockton, CA 95201 460-67%' 1 <br />1' 40 10/80 <br />