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INYENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> FaciLity Name: Morton Paint Company Tank ! Size Product <br /> v2. (:0 O Jn/E�'7771 �- <br /> Fatility4ddress: 38 W. Sonora Street eCc) „Ir A�_ G�5 <br /> Stockton , CA 95203 <br /> Telephone : ( 209 )466-4541 <br /> Person Flip <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 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 /> vas not due to an unauthorized (leak) release. (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. RE <br /> pppp���� <br /> Date Sank It Amount CEN E <br /> 2- 7-i2 -9c n G JUL 16 ,ggp <br /> 3- �NVIRONMENTAL PERMIT/SER'flCES�T� <br /> 4. <br /> 5. <br /> Additional dates/am ,uots shall be contioued 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 /> Quarter I - January --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --) rkcember <br /> Send to: SAN JOAQLIN LOCAL HEAL1'li DIS'I'KICI' <br /> 1601 E . I:ar.c 1 I un , P . 0 . Iins 2009 <br /> Stockton . CA 95201 466 -6761 <br /> I(;T 40 10/ 86 <br />