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V <br />ti <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name: S)2 t;/ 7 Jb7 <br />Fac. ity Address: <br />Telephone: 10 <br />Person Filing <br />Report 67r1 <br />nECEIVED <br />JAN 17 1992H <br />ENVIRONMENTAL <br />� ES <br />PERi�I►T . , <br />QI hereby certify under penalty of perjury that all inventory variations <br />the above mentioned facility were within the allowable limits for this for <br />quarter. (No in Column l3 of the Inventory Reconciliation Sheet) <br />i <br />Inventory variations exceeded the allow.: <br />hereby certify under blc limits for this quarter. I <br />penalty of perjury that the source for the variation <br />was not due to an unauthorized (leak) release. (Yes in Colu <br />Inventory Reconciliation Sheet) —' » 13 of the <br />List date, tank #, and amount for all <br />allowable variaCioas that exceeded the <br />limtits. <br />Date Tank # A ounc <br />I- —IL2 / _ * <br />—� i'�—----L_— 25 <br />4- / _� l <br />fi' / 27 <br />s. ! D- --- —1(17 <br />Additional dates/amounts shall be continued on a <br />Piper and attached. separate sheet of <br />If the source of the variation which exceeded allowable limits was dui to <br />a leak the incident shall be reported to S.J .L.li. D. Environmental Lica! ttt <br />Within 2�. hours and an unauthorircd release report submitted. <br />I'Ttc quarterly suammary report shall be <br />quarCer. :ubmi[Ccd within IS ".ty:; ut the Incl of 0,1ch <br />Qu"rCcr 1 - January --) "arch <br />Q'iar[er 2 - April --) June. <br />Quarter 3 - July --> :�cl)ccmhrr <br />t -c -r-" 44 - October --) Ik:ccmber <br />Send Co: `'AN MA 11 <br />Q IN LUCAL HEAL'111 UISTRIC1, <br />1601 F.. Hazelton, 1' . 0 . Box 2009 <br />IICT 40 10/86 Stockton, CA 95201 466-6781 <br />