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IPECEIVE <br />APR 6 101,9 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM PERMITISERVICEVIRONMENTALALT , <br />5 <br />FaciLity Name: <br />1r-acLli,ty,'Address: 14971 1Y. r .. .x ''� ... <br />; <br />Telephone: <br />?-'c?617- <br />Person Filing <br />r • <br />ort A' <br />1741 <br />I hereby certify under penalty of perjury that all inventory <br />the above mentioned facility were within the allowable limsysvarforatithiss for <br />quarter. (No in Column l3 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 />van not due to an unauthorized (leak) releise. (Yes in Col <br />Inventory Reconciliation Sheet) — 13 of the <br />List date, tank f, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank Amount <br />1. <br />2. <br />3. <br />4. <br />S. <br />Additional dates/amounts shall be continued on a separate sheet of <br />Paper and attached. <br />If the source of the variation which. exceeded allowable limits was du` to <br />a leak the incident shall be reported to <br />within 24 hours and an unauthor$ J,L.N.D. Environmental Health <br />ized release report submitted. <br />The quarterly summary report shall be submitted within 15 days of the end of each <br />quarter. <br />Quarter I - January --) March <br />Q*sarter 2 - April --> June <br />Quarter l - July --> September <br />Quarter 4 - October --> tkcember <br />Send to' SAN JOAQU IN LOCAL. HEALTH D I S'l'h I Cr <br />160 1 L. l:aze l t (►n . p . 0 . Ito x 2U()g <br />(.'T 40 10/86 Stockton, CA 95201 466-6781 <br />