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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM JAN 2 4 <br /> FaciLity Name: Morton Paint Company Tank f Size' Product <br /> Facility Address: 38 W. Sonora Street r' no <br /> s <br /> Stockton . CA 95203 <br /> Telephone : ( 209 )466-4541 <br /> Reportpson Fi <br /> L hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were vithin the allowable limits for this <br /> quarter. (No in Column 11 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 /> van not due to an unauthorized (leak) releise. (Yes in Coles 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. <br /> 4. <br /> S. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> Lf the source of the variation whichexceeded allowable limits was due to <br /> a leak the incident shall be reported to S ,J .L . H . D . EovironmentaL Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of Che end of each <br /> quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --> June <br /> Quarter J - July --) Scptcmher <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQLIN LOCAI, HEALTH DISTH1CT <br /> 1601 E . Hazelton , 11 . 0 . Box 2000 <br /> Stockton , CA 15201 466 -67bl <br /> W;T 40 10/ 86 <br />