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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> raciLity Name: Morton Paint Company Tank i Size Product <br /> 3 ' : <br /> lacilitr,'Address: 38 W. Sonora Street /p 00 n L°AJI-F-ad G456/95 <br /> Stockton , CA 95203 <br /> Telephone : ( 209 )466-4541 <br /> Person Fi n <br /> Report <br /> I hereby certify under peoaLty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable Limits For this <br /> quarter. (Ho in Column !3 of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify udder penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (Yes in Column I3 of the <br /> Inventory Reconciliation Sheet) .— <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable Limits- <br /> Date Teak f Amountp 9';�qy <br /> 3. <br /> 4. E1�VIROn,v1'TAL. HEALTH <br /> KRIAIT/SERVICES <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 al-lovable 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 /> etre I - January --> March <br /> �ar[er - April --> June / <br /> Quarter 3 - July --) septemhc- <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN l.0CAL HEALTH DISTRICT <br /> 1601 F„ I:azc 11 (IL) , P .0 . fiox 2009 <br /> Stockton , (:A 95201 466 -6761 <br /> CIGT 40 10/86 <br />