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INVENTORY RECONCILIATION JAN 101990 <br />QUARTERLY SUMMARY REPORT FORM ENVIRONMENTAL HEALTH <br />PERMIT / QGoVir Fc <br />Facility. Name: PUBLIC WORKS <br />Facility'Wdress 1810 E. HAZELTON <br />STOCKTON; CA 95205 <br />Telephone: 468-37 <br />Person Filing JUNE OKUBO <br />Report <br />Tank I Size Prad�ct <br />1 -12,000 NO LEAD <br />%2 7"772-,Q07- 7EGULA-R <br />I hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable tinits for this <br />quarter. (Ko in Column 13 of the Inventory Reconciliation Sheet) <br />QInventory 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 datev tick f, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank / Amount 7 <br />1. <br />12-21--89 1 192 <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 at-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 summary report shall be submitted within IS days of the end of each <br />quarter. <br />Quarter t - January --> March <br />Quarter 2 - April --> June <br />Quarter 3 - July --> September <br />Quarter 4 - <br />Send to: SAN JOAQUIN WCAL HEALI-H DIS•1-HICT <br />1601 E. hazel ton . P.O. Rax 2009 <br />Stockton, CA 95201 466-6761 <br />EH 23 019 10/86 <br />