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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name; WEE T LA` —,= FUELS <br />Facility Address: 3 -�DO a)s ,r��)4+,�Ai&_J <br />Telephone: 7c, 7 <br />Person Filing <br />Report .�"`A �( Wl C .� c re -e <br />41 RECEIVED <br />APR 15 1991 <br />ENVIRONMENTAL HEALTH <br />[T I hereby cgrtify under penalty of perjury that all,-invantory variGationa for <br />the above mentioned facility were within the allowable limits for this <br />quarter. (No in Columa 13 of the laveatory Recoaciliatiga Sheoti <br />Iaventory varistioa$ exceeded the allowable limits fps tbio quarter. I <br />hereby certify under penalty of perjury that the soures fpr the variatiga <br />was not dug to as unauthorized (leak) roleaso. (Yes is Column 13 of the <br />Iavegtory Recoaciliatign Sheet) <br />List date, tank #, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank # Amount <br />2. <br />3. <br />4. <br />S. <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 allowable 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 />Quarter I - .January --> "arch 1 <br />Quarter 2 - April -- une <br />Quarter 3 - July -.> September <br />Quartet' 4 - October --> December <br />Send to; SAN JOAQUIN LOCAL H4ALTH DISTRICT <br />1601 E. Hazelton, P.O. Box 2009 <br />Stockton, CA 95201 466-6781 " <br />UGT 40 10/86 <br />