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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY -REPORT FORD d�ti� � <br /> /� A 2 1 inn <br /> Facility Nauss: eela/ Oc/YG2 I'd Tank <br /> l� [,ENS"�ieMEiV AL iPr"dcfuct <br /> Facility Addream: G C, d <br /> .� CJC> >/ <br /> Telephone : d ' <br /> Person Fi.lin <br /> Report <br /> 2/11110"hereby certify under penaltyof perjury that all inrento variations <br /> Y ry for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Colu=n 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 /> waa. not due to an unauthorized (Leak) release_ (Yea in Colman 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, task 1, and amount for all variations that exceeded the <br /> allowable lisiits. <br /> Date Task P Amount <br /> 1, <br /> x. <br /> 3. <br /> 4. <br /> 5, <br /> ELdditioaal dates/amounts shall be continued oo ,a acpAratr aheet of <br /> paper and attached, <br /> l.f the source of Che variation vhich. cxcecded alltfu:at>;t limits was dui_ to <br /> e leak the incident shall be reported to s J . 1_ p I} Faviroremrncal ticalth <br /> Within 14 hours and an unauthorized release rcporc submifced_ <br /> ITir qUarterly summary report shall br submitted %,ithin t5 days of the rnd of each <br /> quarCrr. <br /> Quarter 1 - January -) March <br /> QUirter 1 -- April June <br /> Quarter 3 - July --) September <br /> Qtiartcr 4 - October --) l}ccembcr <br /> 5rnd r o- SAN JOAQU I N LOCAL HEALTH )I .`iTil ! G! <br /> 1601 E . HaZeI [ r�tt , 1' - U . YO()-, I(1±?'i <br /> Stockton , CA 115201 460 - 67b1 <br /> lir;T r,() 10:186 <br />