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.t! <br /> A N ra <br /> INVENTORY RECONCILIATION( LNVI o-M f, <br /> TAL QUARTERLY SUMMARY REPORT FORM FERMI 1 i,.rs�v,EF?J HE'�LTIy <br /> rC;Es - <br /> FaciUty Name: Morton Paint Company Tank <br /> Size Product <br /> Facility,'Address: 38 W. Sonora Street � 0 'rtf zS <br /> Lr c�7?LEc c� [rj s <br /> -Stockton , CA 95203 <br /> Telephone : 209 466-4541 <br /> Person F i g <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 I3 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 /> was 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 iiotits. <br /> Date Tank f Amount <br /> t. <br /> 2. <br /> 3. <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 toS .J . L_H . D , Environmental Hcalth <br /> within 24 hours acid an unauthorized release report submitted. <br /> The quarterly suammary report shall be Fubmitted vithin 15 days of the end of each <br /> quarter. <br /> Quarter I - .January March <br /> Quarter 2 - April --> June <br /> Quartet - .July --) Septemher <br /> artcr 4 October --> r7 cember / <br /> Send to: SAN JOAQUIN I-OCAL HEALTH DISTPICT° <br /> 1601 E . li.3'r.e i t r+ii , p . 0 . lic)v 2009 <br /> 1(:T 40 10/ 86 Stockton , (.'A 5+5201 460 -6761 <br />