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i <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> ,C12 <br /> FaciLity Hasse: C. car efi� Tank Size,: :- Product <br /> l vov0Ga e <br /> 1fa�cility,Addre�sa:' -�. '."_''�`_'� ".7' /"C3 J�0 <br /> Telephone : <br /> Person Filing ' _ <br /> Report EEE <br /> 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 coluum 13 of the Inventory Reconciliation Sheet) <br /> QInventory 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 no unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> 1.Lis%t date, 'taiak 1,,. and amount for all variations that exceeded the <br /> Allowable liarits. <br /> Bate- Tank P Amoeaat <br /> z_ D CIO <br /> � <br /> 3. -- SEP 2 9 1988 <br /> 4_ <br /> 5. ENV1R0Nr%AENTAL-HEALTH <br /> PERMIT/SERVICES <br /> Additiooai dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> Ff the source 'of the variation vhich. excecded al-lovable limits was dutf to <br /> a icsk the incident shall be reported to S ,) l N D Environmental Health <br /> within 24 hours and an unauthorized release report submitted_ <br /> Iht q-arterly suacmary report shall be submitted within 15 days of the end of each <br /> Quarter I - January -- ) HArch <br /> Quarter 2 - Aprit --> June <br /> Quarter 3 - July _) septemhcr <br /> ¢iartCc 4 - October --) lkcemhrr <br /> Send co: SAN JOAQUIN LOCAL li1-:ALTH D' STRICT <br /> 1601 F - )'.:aze I i (,n , P . 0 . lii):,. 1()01) <br /> Stock Con , CA 95201 460 . 67bI <br />