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NVENTORY RECONCILIATIOXd� <br /> F"VW SPARTERLY SUMMARY REPORT F9W <br /> Lawrence Livermore <br /> Facility Name: National Laboratory Tank size Product <br /> 879-GIUI 10.000 Gal Regular Gas <br /> Facility Address: P.O. Box 808, L-633 879-G2U1 10,000 Gal Unleaded Gas <br /> Livermore, CA 94550 <br /> Telephone: (415) 422-5167 <br /> Person Filing <br /> Report: Wilfred E. Montemayor <br /> I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Invery,, Reconciliation <br /> Sheet) . 7, <br /> (To the Best of my Knowledge) <br /> ' ;ef va 0 <br /> List date, tank #, amount iof ariatlons 5Ad the reason <br /> for exceeding the allowable mits. <br /> Date Tank Amount Reason <br /> 1. (SEE ATTACHED TABLE 1) <br /> 2. <br /> 3 . <br /> 4 . <br /> 5. <br /> Additional dates/amounts shall be continued on a separate <br /> sheet of paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Services of San Joaquin County Environmental Health <br /> Division, within twenty-four (24) hours and an unauthorized <br /> release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15) days of <br /> the end of each quarter. Circle appropriate quarter. <br /> r -- <br /> - ----->M ar <br /> c <br /> h <br /> Quarter 2 April -- >Jun <br /> Quarter uy� .......> ep <br /> ember <br /> Quarter 4 October --------->December <br /> Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E. Hazelton Ave. , P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 468-3420 <br />