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�=£ <br />�5 <br />fill <br />INVENTORY RECONCILIATION <br />k QUARTERLY SUMMARY REPORT FORM ENVIRCrviENTAL HEALTH <br />F ERM!T/SERVICES <br />I1, ,144LUty,Name! LONE STAR INDUSTRIES, INC. <br />30350 S. Trac Blvd. <br />a rsaittcy Address. Y <br />Tracy, Ca. <br />9537 <br />�a <br />'Telephone: 209-835-1454 <br />Person Filing <br />Report BILL KELTON <br />Tank f Sise <br />Product <br />1 1 000 <br />n ea e <br />2 10,000 <br />ese <br />14, 1-000 <br />Diesel 562 <br />60 <br />1 Waste Oil <br />1-7,000 <br />Diesel (562 <br />I hereby certify under penalty of perjury that all inventory variations for <br />t <br />the above mentioned facility were within the allowable limits for this <br />quarter* y <br />4 (No is 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 />vas not due to an unauthorized (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank #, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank f 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 />,';x ;. €J f, the source of the variation which. exceeded at-lowable limits was due to <br />r a leak the incident shall be reported toS . J . L . H . D . Environmental Health <br />it%thin 24 hours and an unauthorized release report submitted. <br />k ss 4 <br />`ht quarterly summary report shall be submitted within 15 days of the end of each <br />quarter. <br />Quarter 1 - January --> March <br />' Quarter 2 - April --> June <br />Quarter ) - July --> Septemht!r <br />Quartet4 - October --> December <br />Send to:-1iSAN JOAQUIN LOCAL Hf:AL1DISTRICT <br />H,..; 1601 E. Ilar_e 1 toll , 1' .0. ROX 2009 <br />Stockton, CA 95201 466-6781 <br />IG 40 10/86 <br />