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;J n <br /> • . <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM L\ EpSZH <br /> FscLlity Names SOUTH C. Tv Foop Tank I Stse. <br /> Product <br /> ricLti� Addresat o00 5 <br /> y' 1305 C<l�onl Av Z <br /> , <br /> . •• >F<cAto <br /> Telephone : Zoq/ g3R - q <br /> Person Filing <br /> Report �. 6 l 197,C/nJ <br /> ® L 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. (Ho in Column 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) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheec) <br /> List date. tack /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Sank ! Amoun[ <br /> ]. l <br /> 4. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> It 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 Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be eubmittcd within IS days of the end of each <br /> Qu.rtcr. <br /> Quarter I - Jaouary --> March <br /> Quarter 2 - April --> June <br /> Quarter 7 - July --) Scpcemher <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HE:AL1'li DISTRICT <br /> 1601 E. liazelttai , P . O . Box 2009 <br /> Stockton , CA 95201 466-6761 <br /> ucT 1.0 10/ 86 <br />