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w <br /> INVENTORY RECONCILIATION <br /> A' QUARTERLY SUMMARY REPORT FORM <br /> L`,� Namo UYy/�L/ 77�� Tank i Size Pcoducc <br /> lity�\ has: t/2- <br /> u v <br /> Telephone : / e)//'5F <br /> Person Filing <br /> Report <br /> ErL 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 in colu® 13 of the laveacocy Reconciliation Sheet) <br /> inventory variations exceeded the allowable Limits for this Quarter. L <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) celeaae. (Yes in Column 13 of the <br /> inveatory Reconciliation Sheet) <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank 0 AmouaC <br /> 1. <br /> 2_ <br /> 4. <br /> S_ <br /> Additional dates/amounts shall be concioued no a separate sheet of <br /> paper and attached. <br /> Lf 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 . D. Environmental llealch <br /> Within 24 hours and an unauthorized release report submitted. <br /> The Quarterly sugary report shall be submitted within 15 days of the end of each <br /> Quarter. <br /> Quarter I - January --) March <br /> ar 2 - A ril --I uucj3 <br /> artcr I - July --> September <br /> Q%.arcer 4 - October -- •cembcr <br /> Send to: SAN JOAQUIN 1.0CA1. HEA1.1.1i DISTRICT <br /> i 1601 E . Haze Ilnn • P .O . Hnx 2009 <br /> Stockton , CA 95201 466 -61b1 <br /> Uc;1' 40 10/H6 <br />