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fl <br /> INVENTORY RECONCILIATION 8119-87 <br /> QUARTERLY SUMMARY REPORT FORM <br /> ENVIROMENTAI. HEALTH <br /> V-ERM1T/SERVICES <br /> FaciLity Name: Marton Paint Company Tank ISix Product <br /> lacility,'Address: 38 W. Sonora Street s.Zto <br /> ckton CA 95203 <br /> Telephone : _.� 209 )_4b6-4541 <br /> Person F <br /> Report ( ) , Ivy-b�;. <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 /> 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 Column 13 of the <br /> Inventory Reconciliation Sheet) . <br /> List date, tank I, and amount for all variations that exceeded the <br /> allowable litnits. <br /> Date Tank f Amount <br /> k7 <br /> 2. /p- r (D <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 to J . L.H D . Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be Fubmitted within 15 days of the end of each <br /> quarter_ <br /> Quarter I - Jaouary --) March <br /> Quarter 2 - April <br /> art- e 7 - July -_) Scptcmb(-r 7 <br /> Quarter 4 - October --) December <br /> Send co_ SAN JOAQUIN LOCAL HEALTH DISTRICI' <br /> 1601 E . l;nrc l t iin , P . 0 . Box 2009 <br /> Stockton , CA 95201 466 -6761 <br /> U(.T 140 10/ 86 <br />