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PQM <br /> 4C <br /> INVENTORY RECONCILIATION <br /> J� P� <br /> QUARTERLY SUMMARY REPORT FORM NMEN`P\- �c . <br /> - <br /> FaciLity Name: Morton Paint CompanyEN BERM <br /> Tank If Size Product <br /> Faeilitly4d4ress: 38 W. Sonora Street <br /> Stockton . CA 95203 <br /> Telephone : 209 466-4541 <br /> Person Fi1i�g� �L <br /> Report r rte_.; �1 �l �1�n�p2�c <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. (Ha is Column 13 of the Inventory Reconciliation Sheet) <br /> QInventory 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 Colum 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 f Amount <br /> 1. 1 3- E-9 2- <br /> 2. <br /> 4. <br /> S. <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 to <br /> Within 24 hours and an unauthorized release report D . EnvironmentalHealth <br /> The Quarterly summary report shalt 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 --) Scptcmher <br /> Quarter 4 - October --) tkcember <br /> Send to: SAN JOAQUIN LOCAL HEALT'li UIS'I'HIC'I' <br /> 1601 E . Hazclinn . P . O . hos 2009 <br /> 40 10/ KG Stockton . CA x/5201 466 -6761 <br /> ICT <br />