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INVF-NTORY.RECONCZLZATZ0 <br />UARTERLX SUMfMARY REPORT At - Ghia h -r q , /991 <br />f <br />. • <br />Telephone: —_(2o9 9 - 2-0 <br />Person Filing <br />Report: _ n XO&M art <br />V I hereby certif�i under penalty of perjury that all inventory <br />variations for the above mentioned facility were within the <br />allowable limits for this quarter. (No in column 13 of the <br />Inventory Reconciliation Sheet.) <br />Inventory variations exceeded the allowable limits for this <br />quarter. I hereby certify under penalty of perjury that the <br />source for the variation was not due to authorized (leak) <br />release. (-Y-es in Column 13 of the Inventory Reconciliation <br />Sheet) . <br />List date, tank 01 amount for all variations and the reason <br />for exceeding the allowable limits. <br />Pate TAAmount- Reason <br />1. <br />2. <br />3. <br />4. <br />5. <br />Additional dates/amounts shall be continued on a separate <br />sheet <br />of paper . • attached. <br />If the source of the variation which exceeded allowable limits <br />was due to a leak; the incident shall be reported to Public <br />Health Services of San Joaquin County Environmental Health <br />Division, within twenty-four (24) hours and an unauthorized <br />release report submitted.- <br />The <br />ubmitted. <br />The quarterly summary report shall be submitted within fifteen (15) days of <br />the end of each quarter. Circle appropriate quarter. <br />Quarter <br />>September <br />Quarter October <br />Sen• ,JOAQUIN PUBLIC HEALTH SERVICES REN01"T <br />ENVIRONMENTALDIVISION <br />11 <br />1601 E. Hazelton Ave., P.O. .. <br />2009ENVIRONMENTAL HEAL <br />Stockton,• <br />(209) 468-3420 1] <br />