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INVENTORY RECONCILIATION C/' — 3p '�2r <br /> QUARTERLY /SUJMMARY REPORT FORM <br /> Lracility Nave= /�./a fjq �.�C�ugc/PI'�nj Tank 0 Stse <br /> Product <br /> Baeility Addenast 11W lJ J -� /C70D <br /> ' ,'e. J— <br /> c <br /> Telephone : pc = 7 <br /> Person Filin� <br /> Report �rJ ��Z <br /> I hecewf under y penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (Ho in CoLumn 13 of the Inventory Reconciliation Sheet) <br /> ❑ loventocy variations exceeded the allowable limits for thin quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> wag not due to as unauthorized ( Leak) rclease. (Yes in Column 13 of the <br /> Euveotory Reeoociliation Sheet) I <br /> List date, tank f, and sasount for a1L variations that exceeded the <br /> alLowable Limits_ <br /> Date Tank 1 AmouaC1. <br /> 2. <br /> 3. """ OCT <br /> 3 <br /> 4 1988 <br /> ENVIRONMENTAL HEALTH <br /> S. PERMIT/SERVICES <br /> AGdiCioaal daces/aaounca shall be continued on a separate sheet of <br /> paper and accached . <br /> if Che source of (he v2ri260n -11401 rxce,ded allu�able limits vas due Co <br /> s Ieak `Che inecden( shall br reported cn S . J . 1. . 11 _ D . Environmental Ilcalrh <br /> vichin 24 hours and an un.r.lchor. ze..d rcicasr rcporc suboicccd. <br /> nee Quarterly suma.acy report shall be subm. t(ed .within 0 days of the end of each <br /> qusceer . <br /> Quarter I - January --) March <br /> arCCr 1 - April --) Ju.1r <br /> Q.•a rCer 4 - October --> n-'ccmhCr <br /> Send co: SAN JOAQUIN LOCAL HEA1.1-1i DIS'1'H1C'1' <br /> 1601 E . 1!aze l l .ul • 11 .0 Ilex 2009 <br /> 40 10/H6 Stockton . CA '/5201 466-6761 <br /> U1;1' <br />