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INVENTORY RECONCILIATION <br /> QUARTCRLY SUMMARY REPORT FORM <br /> Facility Naafe: D . H . WINN TRUCKING , INC . Tank Size Product <br /> Facility Address: 19555 North Tully Road <br /> P X 24 <br /> Telephone : 209-727-5531 <br /> Person Fill'_ <br /> Report <br /> T NI KIR: PRT' ICK <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 /> DInventory 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, tack f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date 'Tank f Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <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 al'lowabLe limits was dui: to <br /> a leak the incident shalt be reported to S .J ,I.,H . D . Environmental HeaIth <br /> Within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be Fubmittcd within 15 days of the end of each <br /> quarter_ <br /> Quarter I -- January --> March <br /> Quarter 2 - Apri l --> June ` <br /> Quarter 3 - July --> Scptcmb<-r <br /> Quarter 4 - October --> Ikcember { <br /> CIEP <br /> Send to: SAN JOAQUIN LOCAL HEALI-H DISTRIC"i' <br /> 1601 F. . liaze I i oil . P .O . Eio x <br /> SLockton . CA 95201 466-6761 <br /> LJGT 40 10/ 86 <br />