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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> SOUTH COUNTY FOOD 8 FUEL COMPANY <br /> Facility Name: 1737 Barbera Court Tank # Size Product <br /> IEsGalgpy GA 95 ag 10100 Sr A.' 0n/- <br /> Facility Address: 1.305 S. Esc& (*� 1;✓e^� O 60 Re Le<d< <br /> F<c&lo.F CA 9S310 3 8 000 (2e-'. 0^1- <br /> Telephone : .109- ?39-1335 <br /> Person Filing <br /> Report ync.rk <br /> 1 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 Column 13of the Inventory Reconciliation Sheet) <br /> ElInventory 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 unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank #, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank # 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 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 submitted within 15 days of the end of each <br /> quarter. <br /> Quarter 1 - January --) March <br /> Quarter 2 - April --) June n��'�/(,.�� %�' ('In11f?aQuarter ] - July --) SeptemberV �:+�'`�'i"1 r <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT ^ 1987 <br /> 1601 E . Hazelton , P . O . Box 2009 ENVIROMENTAL HEALTH <br /> Stockton , CA 95201 466-6781 PERMIT/SERVICES <br /> UCT 40 10/86 <br />