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0 <br /> INVENTORY RECONCILIATION JUL 28 1989 <br /> QUARTERLY SUMMARY REPORT FORM ENVIRONMENTAL HEALTH <br /> � ( II-- PERMIT/SERVICES <br /> Facility Name: ��r ` l��/►SCCVN rank Size Product <br /> Facility Address: <br /> 6.50 S O 0,4g <br /> - <br /> Facility <br /> J(� <br /> Telephone : 3 SS <br /> Person Filin <br /> Report <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 /> ElInventory variations exceeded the allowable Limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> win not due to as unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank b, and amount for all variations that exceeded the <br /> . allowable limits. <br /> Date Tank E Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> ' 5. <br /> Additional dates/amouats shall be continued on a separate sheet of \ <br /> paper Ind attached_ <br /> If the source of the variation which exceeded allovable limits was due to <br /> a leak the incident shall be reported to S .J .L . H . D . Environmental 11ealth <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted vichin 15 days of the end of each <br /> quarter. <br /> Quarccr I - January --> lt.irctti <br /> QAartc r 2 - April <br /> Quarter 7 - July --) September <br /> Qjarter 4 - October -) lkccemher <br /> Send to: SAN JOAOU IN LOCAL HEA1.Th DISTRICT <br /> 1601 i•: . Ir.;tr.c l t ruZ . l' . cl . f'..�:•: IUCI') <br /> SLockC011 . CA 95201 46f) - fi781 <br /> [ICT 40 10/ 86 <br />