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pal <br /> ��°I° a t <br /> - EE <br /> INVENTORY RECONCILIATION JAN 41 C.D <br /> / QUARTERLY SUMMARY REPORT FORM ENVIRONM E F" <br /> PERINI11 <br /> Facility Name: Morton Paint Company Tank i Size <br /> Product <br /> 2 lJn/u.Lcl Gros <br /> Faeiliccooy Adareaa; 38 W. Sonora Street s <br /> Etonkton . CA 95203 <br /> Telephone : ( 209 )466-4541 <br /> Person Filing n <br /> Report Aa(N.,A'-4�, lf/e/s . .moo <br /> Ef'�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 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1- i-a -9 o z — 0 <br /> 2- - a 90 _J <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates amounts 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 toS .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 --) (kcember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Haze 1 t un , P . 0 . li()x 2009 <br /> 40 10/ H6 (/ <br /> SLockton , CA 51.01 466 _6781 <br /> u:T <br />