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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: DELICATO VINEYARDS Tank I sizes Product <br /> 1 <br /> 10,000 Leaded Gas <br /> Faeility<Address: 12001 SO. HWY 99 12 110,000. Unleaded as <br /> MANTECA, CA 95336 3 30, Diese <br /> Telephone : (209) 982-0679 **AND NO OTHERS** <br /> Person Filing <br /> Report Richard D. Larson <br /> ❑X 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 /> laventory 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) releise. (Yes in Colu® 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 I Amount <br /> 1. RECEIVED <br /> 2. JUL 161990 <br /> 3. ENVIRONMENTAL HEALTH <br /> 4. PERMIT/SERVICES <br /> 5. <br /> Additional dates/amouats shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J .L.H . D. Environmental Health <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 each <br /> quarter. <br /> Q _rcer I January --> March <br /> � Quarter 2 - April --> June]) <br /> Quarter 3 --—July > -Scptcmh(!r <br /> Quarter 4 - October --> Dkccmber <br /> Send to: SAN JOAQUIN LOCAL HEALTH DIS'T'RICT <br /> 160L E. Hazelto') . P .O . Box 2009 <br /> Stockton . CA 95201 466-678L <br /> T 40 10/ 86 <br />