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r✓ ,r� <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> PaeiUty. Names ILA) ///at Tank Size. Product <br /> Facilitp,Addresas 7 / <br /> � . <br /> Telephone : J) 33-93(oG, <br /> Person Fil ng _ � e ��� <br /> Report �I�x <br /> 0 1 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 is Column 13of the Inventory Reconciliation Sheet) <br /> r� <br /> m <br /> Inventory variatibus exceeded the allowable limits for this Quarter. ' I <br /> bereby certify under penalty of perjury that the source for the variation <br /> was not due to as unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List dates tank fv and amount for all variations that exceeded the <br /> allowable liwits. <br /> Date Tank ! Amount <br /> /93- <br /> 2. 30'7---,-Z IyN— �iak 997' <br /> 07— / //7- 4,4iL cont . <br /> 4. 8/ — 307- / /38 Y' /95-- <br /> s. aQ 307-3 i83- �� asb - • <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 due to <br /> a leak the incident shall be reported to S.J .L.H.O. Environmental Health <br /> Within 24 hours and an unauthorised release report submitted. <br /> Quarterly summary report shall be submitted within IS days of the end of each <br /> uarter. <br /> Quarter 1 - January March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December <br /> d to: SAN JOAQUIN LOCAL HEALTH UISTNICT <br /> 1601 E. 11a7Qlt(1n . P .O . 11ox 2009 <br /> Stockton . CA 95201 466-67b1 <br /> ;T 40 10 <br /> cr// _!Sc 3C7- 1 /S�9ff�uc . //�-- <br /> r7 <br />