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INVENTORY RECONCILIATION JUL G 1989 <br /> QUARTERLY SUMMARY REPORT FORM <br /> ENVIRONMENTAL HEALTH <br /> PERf�Alti SERVICES <br /> laeiiity Names _ SnvT0 Coun�TU jE4bf fuEe tank f Stte. <br /> Prouuct <br /> lieilit Addrasas ° 0O0 v� 'L <br /> .6 C, . ;> r- <br /> E<cAte.., eJCE D6 <br /> Telephone : ?c / Y`3 f'. - f 33 ; <br /> Person kLLing <br /> Report ; . L . (4 J2 147 1 ti <br /> ® I 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 Inventory Reconciliation Sheet) <br /> ❑ Inventory variations exceeded the allowable Limits for this Quarter. i <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorised (leak) rel"de. (Yes in Column IJ of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f. and amount for all variations Chat exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> if Che source of the variation which. exceeded allowable limits was due to <br /> a leak the incident shall be reported to S .L.H . D. Environmental Health <br /> Within 24 hours aad an unauchorizcd release report submitted. <br /> The Quarterly sum ry report shall be xubmitted within 15 days of the end of each <br /> Quarter. <br /> Quarter 1 - Jaauary --) March <br /> ! Quarter 2 - April --> June <br /> Quarter ) - July --> September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH UISTKICT <br /> 1601 E . Hazelton , P .O . Roc 2007 <br /> Stockton . CA 75201 466-6761 <br /> ucT 40 10/86 <br />