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OCT 310 <br /> INVENTORY RECONCILIATION ENVIRON VI&i AL HEI;,i-i Hl <br /> PERMIT /,-'.-'?VICES <br /> QUARTERLY SUMMARY REPORT FORK <br /> FaeLLLty Names oSourn �uivfeo Tank ! Size Prouuct <br /> MOS !U S / U us'c.0 <br /> FieLlitr'?Addresat ams_ S 2:3ewe v Avg 6_ue <br /> ' €-��,fICUJy f! 95:3u •- 'oeo tNoEO <br /> Telephoner C�74) 835-1339 <br /> Person Filing <br /> Report i'� 1 114 S NRnTr <br /> 1� I hereby certify under penalty of perjury that all inventory variations for <br /> the above eeencioned facility were within the allowable Limits for this <br /> Quarter. (No in Colum 13of the loventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable limits for this quarter. 1 <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (yen in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date. tack /. and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank Mount <br /> f <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additioeal daces/amounts shall be continued oo 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 <br /> S .J .L.H.D. Environmental Hcalth <br /> within 24 hours and an unauthoriu d release report submitted. <br /> The Quarterly sun ry report shall be submitted within 15 days of the end of each <br /> Quarter. <br /> Quarter 1 - Lowry --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> sepcemher <br /> Quartcr 4 - occobcr December <br /> Send co: SAN JOAQUIN LOCAL HEALTH DIS'I'HICT <br /> 1601 E . I1azcit4111 , P .O . Ho:c 200) <br /> Stockton , CA 95201 466-6761 <br /> UCT 40 10/ 86 <br />