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INVENTORY RECONCIL' IATIOh <br /> QUARTERLY SUMMARY REPORT FORM C(Y1ant6m, , c&vAckva <br /> facility Name: ;toe_ tc:•� �,�;;t���� ��c�oo \ � St- Tank # Size JJ Product <br /> okAE_ iC� c CCS t Sr`_L <br /> Facility Address : 193a K. . El P', ��� D ���•c_ . SL_ <br /> 4_ <br /> Te ephonc: 14474o6�' 00C, C, s <br /> Person filing <br /> Report: G 1-� -.5 L� -t b v, E <br /> p a. 1 <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 /> a 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 . q - h _ 90 �►JE— + i 4i ��ilo�S <br /> 2 . 9 -,, I -9O 134 <br /> 3 . cl -.1.9 - `1 ' `t- <br /> 4 . 9 a t - 9CC b -a--- It <br /> 5 . 9 - I 1 -- 9 C> -T-:_,_ C- + ti <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 - January---------=>March <br /> Quarter 2 - April------------>June <br /> Quarter 3 - Jul ,,i <br /> y------------->September e- , <br /> Quarter 4 - October---------->December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT PAR 0 1991 <br /> 1601 E. Hazelton, P.O. Box 2009 ENV;1'Z0NMENTAI.HEALTH <br /> Stockton, CA 95201 468-3420 PERMIT/SERA/ICES <br /> LI1 23 019 10/86 <br />