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—IS99aly <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT PORN 4 <br />1989 <br />Facility. Names PUBLIC WORKS Tank P R <br />T Product <br />F.Acility'Wdress: 1810 E. HAZELTON 00NO LEAD <br />s.., 12,000 rREGULAR <br />QXQ <br />G.i�.TAAi LiL.95205 .•.10..000 DIESEL <br />Telephone: 468-3 07 4 <br />Person Filing <br />Report JUNE OKUBO <br />ElI hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were vithin 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 unauthorised (leak) releise. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) f <br />List date@ tank ft and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank # Amount <br />2. <br />3. <br />4. <br />5. <br />Additional dates/amounts shall be- continued on a separate sheet of <br />paper aced 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 15 days of the end of each <br />Quarter. <br />atter January --> March fi <br />tarter 2 - April --, June <br />Quarter 3 - July --> September <br />Quarter 4 - October --D December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazelton. 11.0. Eley 2009 <br />Stockton. CA 95201 466-6761 <br />EH 23 019 10/86 <br />