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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM (MoTvt6- pg. CdJti/nck� �'s) <br /> Facility Name : `�t�ti4= �� L v� � 'ZA j).)[Tank # Size JJ Product <br /> uki L C c r <br /> facility Address : 19 -31 k�. F_. 915 <br /> , r <br /> Telephone: X14 <br /> Person Filing <br /> Report:_ <br /> I hereby certify under penalty of perjury that all inventory variations <br /> ❑ for the above mentioned facility were within the allowable limits for <br /> this 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 varia- <br /> tion was not due to unauthorized ( leak) release. (Yes in Column 13 of <br /> the Inventory Reconciliation Sheet ) . <br /> List date, tank # , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tank # Amount <br /> 1 . O e2M) L'KA -t <br /> 2 . Z1 - O r a,006 }�Q c� + <br /> 3 . <br /> 4 . <br /> 5 . � - '� - `�C' 5l <br /> Additional dates/amounts shall be continued on a separate sheet <br /> paper and attached. <br /> If the source of the variation which exceeded allowable limits was <br /> due to a leak, the incident shall be reported to San Joaquin Local <br /> Health District; Environmental Health Division, within twenty-four <br /> ( 24 ) hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15 ) days <br /> of the end of each quarter. <br /> Quarter 1 - Januar [) �� <br /> Q January <br /> Quarter 2 - April 4,-` <br /> 1� <br /> Quarter 3 - July------------->September <br /> MAR 2 0 1991 <br /> Quarter 4 - October---------->December <br /> ENV;RONNIENTAL HEALTH <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT PERMIT/SERVICES <br /> 1601 E. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 <br /> LI] 23 019 10/86 <br />