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0 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name: <br />Facility Address: -p X00 E. FRE_N10NT ST <br />UUK I UN, UA 95 14 <br />Telephone: �"o l'4 � (9 �� .,t__- <br />Person Filing '�� <br />Report 'E'd 21 rc p T <br />APR Q 5 1993 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />L 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) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank 1, and amount for all variations Chat exceeded the <br />allowable limits. <br />Date Tank f Amount <br />1. <br />2. <br />3. <br />4. <br />S. <br />lldditional dates/amounts shall a continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which. exceeded 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 submitted within 15 days of the end of each <br />quarter. <br />QiarCer I- Januar�-- March <br />arter 2 <br />Quarter 3 - July --> leptember <br />Q„arter 4 - October --> I}rcemher <br />Send to: SAN .10AQU IN LOCAL HEAL'1'li <br />1601 K. faze I t (in , P.0- Kwx 711(1') <br />Stockton, CA 95201 46(,-O/b1 <br />11C], 40 10/86 <br />