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Attn: UnderEround tank division <br /> 2nd qui.._ ter, 1991 <br /> 914�ak-4 I, Flailed 7-12-91 from rizrr�l <br /> J U L 1 7 11991 INVENTORY RECONCILIATION route mail box <br /> ENVIRONMENTAL HEAL-RUARTERLY SUMMARY REPORT FORM <br /> PERMIT/SERVICES <br /> Facility Names _Ser�-)aI s Tank r1E Size. Product <br /> FaciLity;Address; 85 ,ouisc� ' Suer-Un1 <br /> 1 ?_ C�00 unleaded. <br /> ia .row, a. a 2, Renu a.r <br /> Telephone : ?ng 983 914.0 <br /> Person Filing <br /> Report John J. ems _ <br /> L hereby cerlafy 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 /> Inventory 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 Chat exceeded the <br /> allowable limits. <br /> Date Tank Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which- exceeded allowable limits was due to <br /> a leak the incident shall be reporter! 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 submitted within 15 days of the end of each <br /> quarter_ <br /> Quarter I - January --) March <br /> Quarter 2 April -_-_> June <br /> Quarter^3 July ^--) JepCCmbr:r <br /> Quarter 4 - October --) lkcember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Haze 1 t cin . P . 0 . Rox 2009 <br /> Stockton , CA 05201 466-6781 <br /> UCT 40 10/ 86 <br />