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INVENTORY RECONCILIATION , <br /> / v QUARTERLY SUMMARY REPORT FOUM ' <br /> Fac i Li ty. Haase: A-/V1-PAA /Yr1yY1 rank <br /> Fac£lity•�Addreae: 57 /- v/SF �� <br /> v �2 <br /> o �p <br /> -T/7� -1Z c/� ys'�s'v 4 <br /> Telephone : _�0 9 rf�.f'rP 6f- <br /> Person <br /> a� o od s U <br /> Person Filing <br /> Report <br /> ® I 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 tht Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable Limits for this <br /> quarter. ' I <br /> hereby certify under penalty of perjury..that the source for. the variation <br /> was not due to an unauthorized (leak) release. (Yes in Column'13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount For all varintions that exceeded the <br /> allowable limits_ <br /> Date Tank <br /> :ru ?' <br /> Ell TD <br /> l_ 0 CT 2 9 1992 <br /> z' ENVIRONMENTAL HEALTH <br /> 3. PERMIT/bERVICES , <br /> 4. <br /> Additional date5/2=u0tt shall be contiaued on a separate sheet of <br /> paper and attached. <br /> If the source of Che variation vhich. excecded allowable limits was due Co <br /> A leak the incident sha11 be reported to S .J .L. H . D .' Environmental Health <br /> Within 24 hours and an unauthorized release report submitted. <br /> quarterly summary report shalt be r.ubmitted vithin 15 days of the end of each <br /> quacCcr. <br /> QuacCcc_1_ <br /> - y--e- <br /> 1' 'Zr-Cc-c 2--.-_A p r_i_t--- --> .1 u n e <br /> Quarter 3 - July --> Septcmhor <br /> Quarter 4 - October --> D}-comber <br /> Send co: SAN JOAQUIN LOCAL •HE✓ALTH DISTRICT <br /> 1601 1: . Ha•r.e 1 Lo n , P . O . lacy 2001) <br /> Stockton , CA -95201 466 -6781 <br /> UCT 40 10/ 86 <br />