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PR 0 , .7 <br /> INVENTORY RECONC IL IAT ION ENVIROrViENITAI_ HEALTH <br /> QUARTERLY SUMMARY REPORT 1~ORM PERMIT/SERVICES <br /> FaciLitp maze: Lod cel' or e Drel Tank I Size. Product <br /> FacilityzAddresa: <br /> Telephone : ___20'? - 7,97-5`/30 _ <br /> Person Filing <br /> Report <br /> I 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. (Ko in Coluc= 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 /> vas not due to an unauthorized (leak) releiBe_ (Yes in Colum 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for 211 variations that exceeded the <br /> allowable limits_ <br /> Date Tank P Amount <br /> 1. <br /> z. <br /> 4. <br /> 5. <br /> Additional datez/.:mounts shall be continued on a separate sheet of <br /> paper and attached. <br /> It the source of the variation which. exceeded .31 lovable limits was due to <br /> a Icak the incident shall be resorted to S ..) . L . H . D . Environmental Health <br /> within 24 hours And an unauthorized release report submitted. <br /> T-hc quarterly summery report shall be Rubmittcd within 15 days of the end of each <br /> y.uactcr. <br /> t <br /> Quarter I - Jaauary --) March <br /> Quarter 2 -- April --> June <br /> Quarter ] - Jisly -,-> >epcemhcr- <br /> Qliarter 4 - October --) Ek-ccmbcr <br /> Send c o: SAN JOAQU IN 1-M."Al, HEA1,Th DISTRICT <br /> 1601 1-: . Hal�vIt ()n ' P _0 _ )009 <br /> Srockcon , ("A 95201 406 - 67bi <br />