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RECEIVEO <br />INVENTORY RECONCILIAT10N <br />QUARTERLY SUMMARY REPORT f P <br />RM' <br />Facility Name: T L` HEALTH <br />_ Tank 'I<. J .. <br />Product <br />Fac. icy Address:�� .. ' �l�cyc.'c' <br />Telephone: <br />Person <br />M <br />L <br />Report:El ��� <br />I hereby certify under pcnaLtp of perjury that all inventory v <br />arions <br />the above mentioned facility were within the allowable limits forathis for <br />quarter. (No in Column E3 of the Inventory Reconciliation Sheet) <br />6e-ventory variations exceeded the allowable Limits for this quarter. I <br />reby certify under penalty of perjury that the source for the variation n <br />was not due to an unauthorized (leak) release. (Yes in Column 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 f A=U13C <br />2_ <br />3. <br />`. <br />Additional dates/amouots shall be continued on a separate sheet of <br />Paper and attached. <br />Lf the source of the variation which exceeded allowable <br />a Leak the incident shall be reported to limits was due to <br />within 24 hours and an unauthorized S . J . L . Ei . D . Environmental Eiea l th <br />rrlease report submitted_ <br />me quarterly summary report shill be submitted withi <br />qu.arCcern IS days of the end of cti <br />Quarter t - January --) Harch <br />Q-.1arter 2 April --> June <br />'. rter 3 July <br />October --> December <br />lend to: SAN JOAQUIN LOCAI. HEAI,TIi DISTRICT <br />1601 F. Hazelton, I'.0. Box 2009 <br />UCT 40 10/86 Stockton, CA 95201 466-6781 <br />