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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: �Ovs�`ic.p Cp L6-V Stove rank I Size Product <br /> Q v� <br /> Facility Address: �Q� <br /> 0 <br /> Telephone : S <br /> Person Filing <br /> Report __ ��k �J �• <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 as unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank AmounC <br /> 2. t a. C,110L'o <br /> 3. <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 allowable limits was due to <br /> it leak the incident shall be reported to; S ..I .L. H . D . Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within IS days of the end of each <br /> quarter. <br /> Quarter I - January --> March <br /> Q*iarte r 2 " - April --> June � fra <br /> Quarter 3 - July --) Septemhrr <br /> !J <br /> Q+,artcr 4 October ' -) I}ccemhcr <br /> Send to= SAN JOAQUIN 1.0CA1, 11E:ALT11 1)1 .`i'1'IlICT JAN 15 '1980 <br /> 1 60 l 1•; . I'in7e� I t e+,l . P . 0 . 1,1-: I""'f EN'VIRCl ENTAL HEALTH <br /> Stockton • CA 95201 /40(r -67b l FERMIT/SERVICES <br /> LI(:T 40 1 t1/ 8r, <br />