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RECEIVED <br />October 24, 1992 <br />1992 <br />INVENTORY"RECONCILIATION ENVIRONMENTAL HEALTH <br />R I o r- mm. <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Hames D S S COMPANY ' <br />JrM—;DEI—E <br />roduct <br />Pacility.-Addresas 639 W. CLAY STREET. ELSTOCKTON, CA.95206 Telephone: 209-948-0302 EL <br />Person Filing <br />Report BOYD GROVES <br />X❑ I hereby certify under pen <br />att of <br />the Above y perjury that All inventory variations for <br />®entioned facilitywere within the allowable lipaits for this <br />quarter. (Ho in Column 13 of the Inventory Reconciliation Sheet) <br />❑ Inventory variations exceeded the allowable limits for this <br />hereby rectifter. I <br />y under penalty of uar perjury that the source for the variation <br />aa■ not due to an unauthorized (leak) releiise. (Yes in Column..13 Qf. the.... <br />Inventory Reconciliation Sheet) <br />List date. teak /, and amount <br />allowable for all variations that exceeded the <br />' limits. <br />Date Tank f Amount <br />z_ <br />J. <br />4. <br />S. <br />Additional dates/amouate :halt <br />PaPcr and aCcachcd. be continued on a separate sheet of <br />It the source of the variation vhich.exceeded at'lovab(e limits vas due to <br />At leak the incident shall be reported to $.J.L.1i.D. Environmental Health <br />Within 24 hours and an unauthorized release report submitted. <br />The Quarterly summary report shall be submitted vithih 15 days of the end of each <br />QuArter. <br />Quarter I - January.--> Hareh <br />Quarter 2 - April --> June <br />Queerer ) - Juty --) Scptcmh<:r <br />QuArter 4 - October --> December <br />Send to: <br />SAN JOAQUIN LOCAL'•IIEAL1'H .UIS'1'ItiC'1' <br />1601 E.. Haze 1 t coil , t' .0, ltox '1.OU9 <br />Stockton, CA 95201 466-67b1 <br />�. 140 10/86 <br />