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1-4-90 <br />INVENTORY RECONCILIATION,t w <br />QUARTERLY SUMMARY REPORT FORIA <br />Facility Hames D S S Company <br />Tank Product <br />Pacility;�lddress539 FI. Cld St.. a1 unleade <br />�tocKion, a. ZU --- Gal --these <br />Telephone: 941-0102 '6 000 Gal diese <br />wasPerson Filing 1 000 Gal em t -remova <br />Report d owes ending <br />® I hereby certify under penalty of perjury that all inventoryv <br />ari <br />the above-entioned facilitr were within the allrrszbl= lims forathiisa for <br />quarter. (Ho in Column Doi the Inventory Reconciliation Sheet) <br />QInventory variations exceeded the allovable limits for thisfor uartec <br />hereby certify under peaalt of perjurysrce q I <br />the variat <br />was not due to an unauthorized (leek)releiseth(yes in Column 13 9f,theion <br />Inventory Reconciliation Sheet) <br />List date, tank 1, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank E /mount <br />Z. — <br />J, <br />4. <br />S. <br />Additional dates/amounts shall be continues nn r m*-p?rste sheet of <br />Paper and attached. . <br />If the source of the variation which exceeded allowable limits was dui to <br />I 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 1 - January --) march <br />Quarter 2 - April --> June <br />Quarter ) - July --) September <br />Quarter 4 - octob <br />Send to: SAN JOAQUIN LOCAL HEALTIt' DISTRICT <br />1601 E. ..Ha7cl t on , P.O. Box 2009 <br />1-0 10/86 Stockton, CA 95201 466-67b1 <br />