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rj <br /> INVENTORY RECONCILIATION APR 71989 <br /> - QUARTERLY SUMMARY REPORT FORM EN'ti'f'-+ON%11FJTALhELTf I <br /> ,^ PERM17'I SEWICES <br /> Facility Name: — reel f S'1, <br /> Tank # Size Product <br /> Facility Address: o✓, ,� C'-E> Z_ <br /> r,!L <br /> Telephone : � <br /> Person Pilin ) off" - <br /> S ti <br /> Report <br /> E] 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 /> i <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 /> van not due to an unauthorized (leak) release. {Yes is Column i3 of the <br /> Inventory Reconciliation Sheet) <br /> Last date, tank #, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 2. <br /> 3. 2 <br /> 4. <br /> 5. <br /> Additional dates/amaunts shailL be continued on a separate sheet of <br /> Paper and attached. <br /> If the source of the variation which exceeded al-lowabLe limits was due to <br /> a Leak the incident shall be reported to <br /> within 24 hours and an unauthorS .J . L. H . D. Environmental Healthized release report submitted. <br /> I <br /> The quarterly summary report shall be submitted within <br /> Quarter. IS days of the end of each <br />+ <br /> t` <br /> Quarter 1 - January - -) March <br /> Quarter 2 - April --> June <br /> Quarter I - July --) September <br /> Quarter 4 - October --} lkcember <br /> Send to: SAN JOAQU Iry LOCAL HEAL1"1i U ISTR ICT <br /> 1601 E. 1!aze I t rola , <br /> tical 40 10/86 SLockton , CA 95201 466 -6761 <br />