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i FROM:ARCO SAN MATED TO: IAR 19. 1991 1.0:22AM ;4392 P.22 <br /> K INVENTORY RECONCILIATION <br /> r ! <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: o�- <br /> 4 Tank Sze Ytt <br /> � <br /> � v I Q ni� <br /> FACility Address: 4g <br /> Parson i..s 1 iny� <br /> Report t <br /> I hereby certify under penalty ofper ur rl <br /> l J <br /> variations for the above met1tionedfacfl tat lnory <br /> allowabao limits for this quarter, yWerewithinthe <br /> Inventory Reconciliation Sheet. ) W-0n column 13 of the <br /> I11v6l4i3Ory variations exceeded the allows le limits for this <br /> i <br /> quarter. 1 hereby `Or"fy udder penalty of penury that the <br /> Source for the variation was not due to authorized (leak) <br /> release, {KU in Column 13 of the Inventory Reconciliation <br /> ' Sheet.) . <br /> Lis" late, tank � , amount for all v.� iatjat <br /> tnt° ek4f: =dint * s and the reqs <br /> J hO allowable limits. <br /> g .' <br /> ° 15 a so F .M <br /> rf3 <br /> v .......-. �Fi' <br /> d.� Aclditlana '_ date;,:/atnoUnt�,; eJl,:, l b:;� co,,tir!l.lc:� on a separate <br /> sheet. of P"j)er 41:-1d attached, <br /> 7f the t3aurce of t11e v;.lriat i cin rah i; _e(, dc,d a 11.0wable limits <br /> M was dile to <br /> ci leak, i:ilE: incif-lrtlt S!l�Zl J;e } <br /> c <br /> r el,c,r- E-d to Public <br /> Health ��P_Y'V�1~ J Gf in J071(1llorl tCu?It'V 1':CI`„ run.ncr 1 �; <br /> n..r al J,ealth <br /> Sia Division, witJllrl Lwer;ty-tplir X24 l;C,ur:; t cl 1n ullaut.horized ' <br /> releaso report i4kibmittod. � <br /> a The quat t :;rly fsl7>`ilmdXy rep�?rt 81'IiS� � k C9 .AL1 F$ t <br /> i `Ile ar7i1 <_f each uarcer. <br /> : ,Lclo <br /> :yit� in fifteen (15) clays 0. , �� ,� <br /> to appropriat_e quarter, <br /> a . <br /> <. Quarter <br /> 'IUilB <br /> - <�Qtlarter_J, - July __ <br /> _._ ..,gept em er <br /> „,': z Quarter 4 - Octcaber - <br /> Send to: <br /> SAN JpAQCJ1I4 C'OUtd'TY PUOLIC HFALT!{ SE VICES <br /> ENVIRONMENTAL HEALI'N llzVISION <br /> 1601 E. Hazelton Ave. , P. O. Box 009 <br /> Stackton C <br /> u� r A 9201 � <br /> EH 23 019 (1.0/89) (209) 468-3420 <br /> t, <br />