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INVENTORY RECONCILIATION QUARTERLY SUMMARY REPORT FORM Facility Name: /%t Xr1gfy,-> 144,0-toi Facility Address: /_ SO�A) £'��orR4' rr e 4yr- YS2 o 5L Telephone o26y 44/5/ -oily Person Fi ing Report o s� APR 17 1989 12rL hereby certify under penalty of perjury that all inventory ve,iatiess `cr the above meocioned facility were within the allowable limits for this Quarter. (No in Column 1) of the Inventory Reconciliation Sheet) ❑ Luventory variations exceeded the allowable Limits for this Quarter. i hereby certify under penalty of perjury that the source for the varistioa was not due to so unauthorized (leak) release. (Yes in Column IJ of the Inventory Reconciliation Sheet) 0 List dacc, tank f, and amount for all variations that exceeded the allowable limits. Date Tank f Amount Additional daces/amouacs h,IL be continued on a separate sheet of Paper and attached, [f the source of the variation which exceeded al -lovable limits was due to • leak the incident shall be reported to S.J.L.H.D. Environmental Ilcalch Within Z4 hours and an unauthoriccd release report submicted- The Quarterly summary report shall be submitted within 15 days of the end of each QVartcr. arty - Janusr- -) flarel, Qin rtcr Z - April --) Jauc Qua rCCr ) - July _-) Scptcmbor Q,u rtcr 4 - OcC06cr --) llcccmbcr Send to: SAN JOAQUIN 1.0CA1, HEALTH DISTRICT 1601 F. Haze l l iul, V.0. hi).x Z009 Stockton, CA 95201 466-67bl OCT 4(1 10/86 "m- "- a "rm "Wom � 12rL hereby certify under penalty of perjury that all inventory ve,iatiess `cr the above meocioned facility were within the allowable limits for this Quarter. (No in Column 1) of the Inventory Reconciliation Sheet) ❑ Luventory variations exceeded the allowable Limits for this Quarter. i hereby certify under penalty of perjury that the source for the varistioa was not due to so unauthorized (leak) release. (Yes in Column IJ of the Inventory Reconciliation Sheet) 0 List dacc, tank f, and amount for all variations that exceeded the allowable limits. Date Tank f Amount Additional daces/amouacs h,IL be continued on a separate sheet of Paper and attached, [f the source of the variation which exceeded al -lovable limits was due to • leak the incident shall be reported to S.J.L.H.D. Environmental Ilcalch Within Z4 hours and an unauthoriccd release report submicted- The Quarterly summary report shall be submitted within 15 days of the end of each QVartcr. arty - Janusr- -) flarel, Qin rtcr Z - April --) Jauc Qua rCCr ) - July _-) Scptcmbor Q,u rtcr 4 - OcC06cr --) llcccmbcr Send to: SAN JOAQUIN 1.0CA1, HEALTH DISTRICT 1601 F. Haze l l iul, V.0. hi).x Z009 Stockton, CA 95201 466-67bl OCT 4(1 10/86