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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Nam1R5 <br /> StPacility yank I Product <br /> AddTelephone : <br /> Person Fil <br /> Report <br /> L hereby certify under <br /> the above the of perjury that all inventory variations for <br /> mentioned facility were within the allowable limits for this <br /> quarter. (No in Column 13of the lavcatory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable limits for this quarter. <br /> hereby rectify under persalt of I <br /> Penalty perjury that the source for the variation <br /> was not due to an unauthorized (leak) rcleiae. (Yes is Gal <br /> Inventory Reconciliation Sheet) 13 of the <br /> List date, tank /, and amount for ALL variations that exceeded the <br /> Allowable 11o,ita. <br /> Date Tank I <br /> Amount <br /> �`" 1 <br /> 2. R 6 <br /> , "J <br /> 3. ,SAN 2 3 13 <br /> r <br /> `. ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> 5. <br /> A-dditional dates/amounts shall be continued on a separate sheet of <br /> Paper and attached. <br /> if the source of the variation which exceeded allowable <br /> a leak the incident shall be reported to limits was due to <br /> ,J . L. H . D, Environmental !(catch <br /> Kithira 24 hours and an unauS <br /> thorized release report submitted. <br /> The quarterly suaraacy report shall <br /> 9uacCcc. be submitted within 15 days of the end of each <br /> QVartl'r I - Januxry --) March <br /> Q•iarCr 1 - Apri l --> June <br /> Q"arC''r I - July --) JcpCcmhc-r <br /> Qvar(er 4 - Occobcr --) t <br /> kcr-mbc:r <br /> Scud to: SAN JOAQU I N LOCAL HEALTH U I S•t'It I C't' <br /> 1601 E . <br /> T 40 10/80SLOckLon . CA 95201 1,60 -G7bl <br />