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p <br /> r <br /> VI# g � ,, <br /> i+ <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM An <br /> / r "Al. N'-P'LI A <br /> Fscillty Name: Ez (Rvc. '+ �I'v «k TRws T c- Tank i <br /> Facility Address: 07? <br /> S,lo fo,r ri4 9S.Zos 000 <br /> Telephone : <br /> Telephone : 9j/L-0o/S oo ; <br /> Person Filing, o0 <br /> Report '24yfoah <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 /> 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 unauthorised (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached_ <br /> if the source of the variation vhicls e<creded allovable limits was due to <br /> a leak the incident shall be reported to S .J A— H . D _ Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submicred virhin 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) tlarch <br /> Quarter 2 - April --) June <br /> Quarter ) _ July __) Septemb..•r <br /> Quarter 4 - October --) (h:ccmber <br /> Send tu: "AN JUAt)UI [q 1.O(:A1. li!`-.4I:1'li I)I :n'1'Klt: f <br /> lhnl G . I''„iytlta� , I' t) Riv )Ut)4 <br /> St o I< Lnn , CA 11`il1) I 46h " 6781 <br /> 40 10/ 84 <br /> .sem <br />