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VA <br /> INVENTORY RECONCILIATTON <br /> QUARTERLY SUMMARY REPORT FORK <br /> ENVIRONMENTAL HEALTH <br /> FaciLfty Ham: �er� �a QOc O Tank Y Sia <br /> prrr <br /> oduct <br /> DCS i es49 <br /> Fscility Ilddreas: „`%da 12l�fl <br /> &,,ra 692 <br /> Telephone :,2 - <br /> Person Filing 0 ,0 <br /> Report <br /> ho-l"II 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 13 of the Inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable limits for this quarter. ' Y <br /> hereby certify under penalty of perjury that the source for the variation <br /> wan cot due to an unauthorized (leak) release. (Yea in Column 13 of. the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for- all variations that exceeded "the <br /> allowable limits_ <br /> date Tank Amount <br /> 1. <br /> z. . <br /> 3. <br /> 4_ <br /> 5_ <br /> Additional datesiamouats shill be conn:� <br /> aucd on r¢ separate sheet of <br /> paper .and attached. <br /> J?, <br /> I.f the ?�aource of the variation which ctCrceed allowable limits vas dut. to <br /> A . leakthe incident shall be reported co - J . 1, H - N Environmental health <br /> within Z4 hours and an unauthorized relcase rcnort submitted. <br /> F <br /> I-hc �uar[,e�frly summary report shall be Fubq,itted uichin 15 days of the end of each <br /> Qu�iC,_r_ <br /> ' Quarto 1 - <br /> January --) Hauch <br /> Qaarter. 2 - April -> June <br /> Quarter 3 July --) SvPCrmh,-r <br /> Quarter -4 - october --) lkcemhc_r <br /> SAN JOAQU Ii'q I_OCA1, HEA1.11'1i i7 i :'1TR 1 C'1' <br /> 1601 F. i;a,tr1 � „i, , P . 0 i',., ; Zf109 <br /> St.ockcon . CA 95201 /-0(,-- 67b1 <br /> 1Jf"T 1,0 1 ,0 u 0 <br />