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� INVENfORY RECONCILIATIO144 <br /> gUAR1EItLY SUMMARY REPORT FORM <br /> Facility llamet J3 p eAmdjow y Tank / Size J Product <br /> / 02000 <br /> Facility Addresst lVw', oil, .7- ly.a1z 10eg <br /> ez. -7 <br /> Te lephone ! _o2ol/ <br /> Person Filit <br /> Report �Mji, <br /> AJ <br /> l 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. (Ito in Column IJ 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 vnrintion <br /> vas not due to an unauthorized (leak) release. (Yes in Column IJ of tlw <br /> Inventory Reconciliation Sheet) <br /> Lint dated tank /t and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> t. <br /> 2. <br /> J. <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 nilowable limits vas dme to <br /> ■ Icnk the incident shnll he reported to S „l •1„11. 1). F.nviro,vsr_atni 11enith <br /> Within 24 hours and nn unauthorized release report submitted. <br /> the quarterly summary report shall be submitted within 15 days of the cod of each <br /> quarter. <br /> Quarter I - January -> Harch <br /> triarter 2 - April --> June <br /> July --> September <br /> �Q1.1tter 4 October --> December <br /> Send to: SAN JOAQIIIN LOCAL 11EAl;1-11 U1S'1'R1C'1' <br /> 1601 E . Hazelton , P .O . Rax 7.009 <br /> Stockton , CA 95201, 666-6781 <br /> UC'r 40 10/86 <br /> kPy <br />