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�y <br /> INVENTORY RECONCILIATION APR 2 11989 <br /> QUARTERLY SUMMARY REPORT FORM ENV i:.-,.,,v-:,'�.'� I iLALTH <br /> PER1VV/SL-RVICES <br /> Facility Name: Cv�--tUP n �✓tSEo✓1 Tank i Size Product <br /> Facility Address: .. <br /> Telephone : 3- 14 CLS- <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 13of the Inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allovable limits for this quarter. ' I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 11 . and amount for all variations that exceeded the <br /> , allowable limits. <br /> Date Tank f Amount <br /> 2. r <br /> 3. <br /> 4. <br /> t <br /> 5. <br /> Additional dates/amounts shall be continued on x separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded allowable limits was due to <br /> Y 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 /> Quarter 1 -- January --> tfarclti <br /> Qjartcr 2 - April --> Juni- <br /> Quarter 3 - July ';eptcmh'!r <br /> Q%jartcr 4 - October =-> 04-comber <br /> Send to: SAN JOAQUIN 1,0CA1. -HEA1.11i U1 :;'1'!1ICT <br /> 1 !x0 1 E. . Haz(' 1 1 I'll , l' . U . i, `. Ic111'} <br /> `O- ockton . CA 95101 466, -Olbl <br /> LICT 40 10/ 80 <br />