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INVENTORY RECONCILIATION APR 1 6 1092 <br /> UARTERLY SUMMITRY REPORT FO* ENVIRONMENTAL H. A TN <br /> FacilityName: �T/ L'` <br /> 2C Tank Product <br /> \ �� � WAV 1n D O <br /> � Facility Address: t-W <br /> 6Uv <br /> Telephone: -'Lo <br /> Person F' l' <br /> Report: � � ar i <br /> ( I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> _ source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Inventory_ Reconciliation <br /> Sheet) . <br /> List date, tank #, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank Amount Reason <br /> 1. <br /> 2 . <br /> Ott- <br /> 3 . <br /> 4 . <br /> 5. <br /> Additional dates/amounts shall be continued on a separate <br /> sheet of paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Services of San Joaquin County Environmental Health <br /> Division, within twenty-four (24) hours and an unauthorized <br /> release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15) days of <br /> the end of each quarter_—.-Cir_cle_ appropriate quarter.----- <br /> Quarter 1 - Janua------------ <br /> y__ >Mal <br /> uar er 2 - April - -->June <br /> Quarter 3 - July ------------>September <br /> Quarter 4 - October --------->December <br /> Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> yys nl. SdH ✓vtqryu' P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 468-3420 <br /> EH 23 019 (10/89) <br />