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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY RFPORI FORM <br />facility Name: —84 <br />/'4fNM10AQ / <br />b G! <br />Facility Address: /SOL AJ. C/ n <br />_ ��eck% r� 9�� ✓ <br />Telephone: <br />Person Filing <br />Report <br />r. <br />RECEIVED <br />MAY 1 1 1990 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />Tank / I Size <br />ls.ec <br />2- <br />/taco <br />c• hereby certify under penalty of perjury that sit inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />Quarter. (No in Colum I7 of the leveatory Reconciliation Sheet) <br />❑ loventocy variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />V48 Got due to an unauthorized (leak) rel"ae. (Yes is Column 11 of the <br />Inventory Reconciliation Sheet) <br />0 <br />List dater taak /. and saount for all variations that exceeded the <br />allowable limits. <br />Date Tank / Amount <br />5. <br />Additional daces/amouats shall be contioued on a separate sheet of <br />Paper and attached. <br />Lf the source of the variation which exceeded al -lovable limits was due to <br />a leak the incident shall be reported to S.J.L.H.D. Environmental IlcalCh <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 />January <br />Qur(.!r 2 - Apr, <br />Quarter I - July --) Sep(emhcr <br />Q.0 r ter 4 - October --) Oeccmber <br />Send to: SAN JOAQIJIN 1,0CI. IfEAI.I'li IJIS'I'I(lC'1' <br />1601 K. Haze l t (ut , V.0. ftw( 2.009 <br />/,0 10/N6SLockton. CA 95201 466-67bl <br />