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0 qRECEIVEL, <br /> INVENTORY RECONCILIATION <br /> MAY 4 fgq0 <br /> QUARTERLY SUMMARY REPORT FORM ENVIRONMENTAL HEALTH;. <br /> PE c <br /> FacWty fume: D . H . WINN TRUCKING , INC . Tank Size product <br /> Facitity .Address: 19555 North Tully Road t <br /> P . 0 . BOX 24 . 1 ockpnrri <br /> Telephone : 209-727-5531 <br /> Person Filing <br /> � <br /> Report <br /> LAI I hereby certify un e 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. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank Amount <br /> 1. <br /> z. <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 /> a 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 f> - January --) N.irch <br /> �artcr 2 - April --> June <br /> Quarter 3 - July - ) septemb(tr <br /> Quarter 4 - October - - > N}-cember <br /> Send to: SAN JOAQUIN 1.0CAI, HEALTH DISTRICT <br /> 1601 H . Haze f t o�n . P - 0 - ROX 2009 <br /> Stockton . CA 15201 466-67b1 <br /> 11c T 40 10/ 80 <br />