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r <br />1116�INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name: <br />G1 EWAL'S GAS & UQUOR <br />Facility Address: 41+00 ;:_, f ;E%40NT ST. <br />Telephone: <br />Person F ling <br />Report <br />4 RP21T Zo <br />JAN 12 1993 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />Tank i Size Product <br />v U � <br />i <br />t <br />r <br />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 />Inventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />vas not due to an unauthorized (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tack i, and amount for all variations that exceeded the <br />allowable limits - <br />1. <br />2. <br />3. <br />4. <br />5. <br />Additional daces/amounts shall <br />paper and attached. <br />Amount <br />continued on a separate sheet of <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 submitted within 15 days of the end of each <br />Quarter. <br />Quarter I <br />QQ.sarrer 2 <br />Quarter 7 <br />Ll ---4 <br />/darter 4 <br />Send to: <br />(ICT 40 10/86 <br />- January --) March <br />- April --> June <br />- July --) $eptCm1,4-r <br />- October --> (kct-mber <br />SAN .JOAQU IN 1.0CA1, 11EA1,11i U I STR I CT <br />1601 E. Haze 1 t +in , P.O. ft. IOW) <br />Stockton, CA 95201 4(o)-O/b1 <br />56P&Ivi- <br />C- Pay <br />