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1poll <br /> ` , y <br /> \X1yV�J APR 10 1,991 <br /> INVENTORY RECONCILIATION ENVIRQNMENTALHEALTH <br /> QUARTERLY SUMMARY REPORT FORM PERMIT/SERVICES <br /> Facility Name: Morton Paint Company Tank f Size Product <br /> tT un[ s <br /> laeility�Address: 38 W. Sonora Street -- 0c, <br /> Stockton , CA 95203 s <br /> Telephone : 209 466-4541 <br /> Person <br /> Report <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 l3 of the Inventory Reconciliation Sheet) <br /> DInventory 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 Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank t, and amount for all variations that exceeded the <br /> allowable Limits. <br /> Date Tank E Amount <br /> 1. :/ a p <br /> 7- A - - 4 o <br /> 3. <br /> 4. <br /> 5. <br /> Additional datesl.+��ats chcll be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded al'lovable limits was due to <br /> a leak the incident shall be reported to S .J . L. H . D . Eavironmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted vithin 15 days of the end of each <br /> quarter. <br /> Quarter I - January --> March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --) Septcmhcr <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTIi DISTRICT <br /> 1601 E . liaze 11 (m , P . 0 . box 2009 <br /> S, ock[on , CA 115201 466 -67b1 <br /> JmT :,0 10/ 86 <br />