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INVENTORY RECONCILIATION <br /> n <br /> QUARTERLY <br /> SUMMARY REPORT FORM <br /> Facility Name: �m 1j �'V�C.` Tank / Size Product <br /> Facility Address: ,�� W • LO�\ 0.40-- Z Ulea <br /> es� <br /> Telephone : Zo —333 - cN777 <br /> Person Fi i g <br /> Report I^�C avtJii 4ekyb. <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. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> E] Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. R Cf 1V V-1) <br /> 2. c:. tgg1 <br /> 3. <br /> 4. t1Sd- <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of tile <br /> e variation which exceeded -allowable limits vas due to <br /> a leak the incident shall be reported to $ „J .L.H . D . Environmental Ncalth <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of cacti <br /> quarter. <br /> Quarter I - January --> Harch <br /> Qvartcr 2 - April --> June <br /> Quarter 3 - July September <br /> Quarter 4 - October --> Ikrcembe_r <br /> �1hAa <br /> Send to: SAN JOAQUIN LOCAL 11LAIJ11 DISTRICT . <br /> 1601 L . I1II7,elfoll , P . O . Box 7.009 <br /> SLOCICCotI , CA 95201. 466-6781 <br /> UGT 40 10/86 LNt�R� ly��v\c�S <br />