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111VEtllollY RECOIICILIATIOR <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: l�Q> �1v1 Cnrl lank t Size product <br /> T �()Ow A <br /> Facility Address: T= � 7jjDO <br /> C�_ <br /> Telephone : <br /> Person Fil* <br /> Report �(�h� \NN)m %GA444— <br /> J� I 1 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 17of the Inventory Reconciliation Sheet) <br /> Inventory variations excec<ied file allownhlo limits for this quarter. I <br /> hereby certify ander penalty of perjury that the source for the variati It <br /> was not due to an unauthorized (leak) release. (Yes in Column U of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> I. <br /> 2.3. <br /> I` d <br /> %. APR 9 �` 1'. <br /> s. <br /> �vVIR��IVt qV � <br /> Additional dates/amounts sball 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 S „J .1-11. n <br /> 1). rnviromeotal 11calth <br /> within 24 hours and an unauthorized release report submitted. <br /> Tile quarterly summary report shall be submitted within 15 Flays of Lite end of each <br /> quaker. <br /> quarter ( - January --> Harch X y\ 0 <br /> Qaarter 2 - April -- 3115c <br /> (hurter 7 - July --) September , <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL IIGALTH UJSTIll.Cr <br /> 1601 E- llaze l.t<m , 1' .0 . ”" 7.009 <br /> SLOCICCOtI , CA (J5201. 4116-6781 <br /> UG'r 40 1.0/86 <br />