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INITORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> iaeiiity Names �0 �� � sa+rJs'fi�✓ TankSun Product <br /> facility Addrnaes x799-3 <br /> Telephone: A/6-00,6- 00 <br /> Person Filing <br /> Report !`!( / r�;1��E <br /> 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 /> 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 as unauthorised (leak) releise. (Yes in Column 13 of the <br /> Ieveetory Reconciliation Sheet) <br /> List date, tack f, and amount for all variations chat exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation whichexceeded zttowable ti=-ts was due to <br /> a Leak the incident shall be reported to S .J .L.H .D . EavironmentaL licalth <br /> within 24 hours and an unauthorised release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I January --) March <br /> Quarter 2 - April --> June <br /> Quarter I - July --> September <br /> Quarter 4 - October .-> December <br /> Send to: <br /> SAN JOAQUIN LOCAL HtAL1'li UIS'I'ItIC'l' <br /> 1601 E. Hazelton , P .O . Box ppR tgg4j <br /> Stockton , CA <15201 466-6761 LTH <br /> x:T 40 10/86 VlK�tvtt..1A&V1CS <br /> EN PERMIT/SER <br />