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RMR9WWWF�T#�M+M�YfgfRlY;aw+w..mry.uw.f+w .S.'.tf'sYR <.'bSHkmJ�" R:tIJ`W.wti.rwwr:.es.vuuvana+.rs:w . —�. . .•._�rw.ru.. <br /> I • • <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Namet _ i[ 1�C7�1 Tank / Size Ctoduct <br /> Facility Address: l.� A.\, Gt1? I1�44u_ <br /> to �` too <br /> 'Telephone : <br /> Person Filii <br /> Reptiy�LVv�&� <br /> tf�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. (No in Column U of the Inventory Reconciliation Sheet) <br /> L_.1 Inventory variations exceeded the Allowable limits for thin quarter. I <br /> hereby certify under penalty of perjury that the source for the vnrintion <br /> was not due to an unauthorized (leak) release_. (Yes in Column IJ of the <br /> Inventory Reconciliation Sheet) <br /> TA Rt date, tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date rank I Amount <br /> 1. <br /> 2. <br /> ]. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall he continued on a Repartte hlleer. of <br /> paper and attached. <br /> If the source of, the variation which exceeded allowable limits wtq dhie to <br /> a leak the incident shall be reported to c3 .,) .1_11 *1) . Environmental Ileatth <br /> within 2.b hours and an untuthorir.ed release reportsubmitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> (starter 1 - January --> !larch <br /> Q•tarter 2 - April --> .Ione <br /> (Mart-e-r-1.- - July --> Sep1'cm1l4!r <br /> tarter-l+-=- October. --) Ilecember <br /> Send to: SAN JOAQUIN LOCA!. IILAI;TII bIS'L'Itl(;'l u fyl <br /> 1601. E . Ilhze ) t.on , P .O . sox 2009 TEB 22 '1989 <br /> Stockton , CA 95201 466-6181 <br /> ENV <br /> UG'r 40 10/86 PERMIT LTH <br /> iSERVICES <br /> 2 <br />