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INVENTORY RECONCILIATION <br />JUARTERLY <br />SUMMARY <br />REPORT <br />i'i. i l 1 <br />FACL14y 4ddress: Stockton, *CA 95207 <br />Telephone <br />/ <br />Person <br />� <br />. <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 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) release. (Yes in Col 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 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 ai•lowable limits was due to <br />a leak the incident shall be reported to S.J.L.H.D. Environmental Health <br />within 24 hours and an unauthorized release report submitted. <br />The quarterly suaimary report shall be submitted within 15 days of the end of each <br />quarter. <br />Quarter I - January --1 March <br />Quarter 2 - April --> June <br />Quarter 3 - July --> September <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazelton. 1' .0 . [lox 2009 <br />Stockton. CA 95201 466-6781 <br />JGT 40 10/86 <br />