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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name; GIWEKE FORD <br /> Tank AWalsasoline <br /> '! ltacilie Address. 1045 So. CZero:ee <br /> ?'' P.O. Box 1210 <br /> i Lonr. �a 95241 <br /> Telephone : — (209) 334-F,500 <br /> Person F 8 <br /> Report <br /> 1 hereby certify under Pcualcy of Perjury chat all inventory variations for <br /> the above mentioned fsczlity. were within the allowable Limits for this <br /> quarter. (No in Column I3 of the Inventory Reconciliation Sheet) <br /> El <br /> Inventory variations exceeded the allowable limits for this quarter ��V�/� ` <br /> hereby certify under penaltyof q @:Y1�ijgo = I & <br /> e va <br /> was not due Co an unauthorized (leak)rreLeaacCh(YeauiaeCoLtm,nfor hl3 op�theion <br /> Inventory Reconciliation Sheet) <br /> JUL 101989 <br /> Allowable limits_ <br /> . <br /> List date, tank and amount for all variations that exceed MEPITALHEALTH <br /> ' �� 'yTlgEt�\�ie^E <br /> Da-tc Tank I . <br /> Amount <br /> f_ <br /> 3. <br /> 4. <br /> Additional dates/amouots shall be continued on a repbratc sheet of <br /> Paper and attached. '. <br /> If the source <br /> • leak the incidd the variation uhich. excecded al'luuable limits was due to <br /> ent 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 re <br /> quarter. Port shall be submitted <br /> with' - IS days off) <br /> he end of each <br /> Quarter I _ <br /> January --) March <br /> Quarter 2 - April --) June <br /> Quacccr 3 _ <br /> Quarter 4 _ July ScPtemhcr <br /> October --> Decurmber <br /> Send cot <br /> SAN .IUAQUIN LOCAL 11EAL1'li Ul5'1'kIC'I' <br /> 1601 li . 1!azcll nt , P . U . 14ox 2009 <br /> 40 l0/ $6 Stockton . CA 95201 466 -6 )1: 1 <br /> T <br />