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` <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: D . H . WINN TRUCKING , INC . 'lank i Product � <br /> Facility-'Address: 19555 North Tully_ Road <br /> P . O . BOX 24 . 1 nr.k2furi <br /> Telephone : 209-727-5531 <br /> Person Filing <br /> Reporter 3 ' <br /> I hereby certify unde penalty of perjury (L 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 /> QInventory variations exceeded the allowable limits for this quarter. t <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorised (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank #, 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 /> 1F the source of the variation which. exceeded al-lovable limits was due: to <br /> a leak the incident shall be reported to S .J ,L. H . D . Environmental Health <br /> Within 24 hours aad an unauthorized release report submitted. <br /> The quarterly summary report shall be Rubmitted within 15 days of the end of each <br /> quarter. <br /> Quarter I -- January --) Harch <br /> Quarter 2 - Apri t --) .wile <br /> Garter 3 - July --) Septcmhr.r <br /> Quarter 4 - October - -) December <br /> 3 <br /> Send to: SAN JOAQUIN LU{:AI, HEALI'li DISTRICT <br /> 1601 E , llazc l' (111 , P . 0 . [4Ox 2OO9 <br /> Stockton , CA 95201 466 -67bi <br /> LICT 140 10/86 <br />