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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: tc.&—,W Cc.LLyiSio✓-\ Tank # size Product <br /> Facility Address: l p (�*. t� ` ]b <br /> furl <br /> Telephone : <br /> Person Filing <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 /> Inventory variations exceeded the allowable 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. (Yet in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> ` allowable liatii[a_ D C Rn file: <br /> Daae Tank al~ Amount APR <br /> 2_ �� ENV,n� :.k iAL t(,.ALTH <br /> FERMI I/SERVICLS <br /> 3- <br /> 4. <br /> .4. a" <br /> Additional dates/amounts &hail be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which exceeded allovablc limits was due to <br /> a leak the incident shall be reported to S .,J , i„ H . Q • 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 cacti <br /> quar(r.r. <br /> Quarter I - January -) Kirch <br /> Q,larter 2 - April --> Juni- <br /> Quarter 3 - July --> Septemhor <br /> Q�iarter 4 - October =-> 1kc4•mher <br /> Scnd to: SAN .JOAQU IN 1.0CA1, HEA1,TH W ."')•r12 I CT <br /> 100 1 El . Haze I 1 (111 . P .0 Po c.: )()1I'} <br /> `>Lockton . (:A 95201 1+(,r, - 67b1 <br />