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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name: GREWAL' GA,(3 & LJC)U0FJ <br />Facility Address: 6TOCKTON, CA 95215 <br />Telephone: <br />Person Filing ' <br />Report SiJ,92r <br />Tank i Size Product <br />ci d ( <br />U"I hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br />QInventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to an unauthorized (leak) releise. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank f, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank f Amount <br />1. <br />f <br />2. <br />3. <br />4. <br />5. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper ind attached. <br />If the source of the variation whichexceeded allowable limits was due to <br />a 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 %ubmitted within 15 days of the end of each <br />quarter. ,/� <br />Quarter I - January --> March L/ <br />Quarter 2 - April --> Jure! IpTIVE0 <br />Quarter 3 - July --> September <br />Quarter 4 - October --) Occember <br />Send to: SAN JOAQU IN I.0C,AI. HEALTH DISTRICT APR 15 1992 <br />1601 E. l:azc• 1 t (,n , P.O. 1..,:•: "I(1tl'1 <br />ENVIRONMENTAL HEALTH <br />Stockton, CA 95201 4Of)-07b1 PERMIT/SERVICES <br />11(;T 40 10/86 <br />i Nl" <br />