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QINVENTORY RECONCILIATI <br /> UARTERLY SUMMARY REPORT 14WZM <br /> Facility Name: �ZFt- GE T Y Tem 1 Tanh size !_ _Product 1. <br /> Facility Address: Z47--J W rE <br /> Telephone: 2CR `t Z -Li 51 <br /> Person Filing <br /> Report: <br /> El I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Inventory Reconciliation <br /> Sheet) . <br /> List date, tank #, amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank Amount Reason <br /> 1. fib-89 E2- MEASoleeMep r E"oR <br /> 2 . <br /> 3 .01--2-4 -$ot <br /> 4. t)6--61 -6 <br /> 5. C)@�'- <br /> Additional dates/amounts shall be continued on a separate <br /> sheet of paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Services of San Joaquin County Environmental Health <br /> Division, within twenty-four (24) hours and an unauthorized <br /> release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15) days of <br /> the end of each quarter. circle appropriate quarter. <br /> Quarter 1 - January---------->March <br /> Quarter 2 - April ------------>June <br /> �qQuarter - July ------------>September <br /> Quarter 4 - October ----------->December <br /> Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> �1� Nin �C. 9rr,h lion--Avg. , P.O. Box 2009 <br /> G Stockton, CA 95201 <br /> (209) 468-3420 <br /> EH 23 019 (10/89) <br />