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jpl��(Cl�l�ll <br /> APR 0 '�' 1987 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FOgbVIROMENTAL HEALTH <br /> FERMIT/SERVICES <br /> Facility Name: 0e/� Tank I Size Product <br /> Facility Address: / AC <br /> Telephone : Sl6G- S9 S <br /> Person Fillg <br /> Report /36t! _ <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. (No in Column I3of the Inventory Reconciliation Sheet) <br /> C1Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was cot due to an unauthorized (leak) release. (Yes in Column II of the <br /> Inventory Reconciliation Sheet) <br /> List date, tack /, sod aaount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2. <br /> ]. <br /> 4• <br /> S. <br /> Additional daces/amounts shall be contioued 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 -1 _ L. H . D . Environmental lieatth <br /> within 24 hours and an unauchorined release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> Quarter . <br /> Quarter I - January --) Harch <br /> Q•iarrer 2 - April --> Juue <br /> Quarter ) - July __) 'September <br /> Q�,arter 4 - October --) Decemher , <br /> Send to: SAN .I0A01JiN 1.0CAI• HEA1.1'h DISTRICT <br /> 1001 1' . I!are11 ui , P . l) 71(1'1 <br /> Stockton • CA '15201 <br /> t11;,l 40 I fl/ M6 <br />