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s l� �irr9 � � �:.^.• <br /> INVENTORY RECONCILIATIC J U L 19 4ni12 <br /> �UARTERLY SUMMARY REPORT 46 <br /> ENVIRONMENTAL. HEALTH <br /> Facility Name: $ G1��- ST�n►� Tan �E��liTf EF y �Ct <br /> �l L <br /> 10,00c> tr <br /> Facility Address: Z4-211sysekktTe NYe <br /> AN-r-ecA. S'331� <br /> Telephone: 2D9 2--3 21St <br /> Person Filing // <br /> Report: 1k<s �QGRS [ <br /> � S-k -TgS <br /> 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. b4- Q$-g t I -4.85 Me.*.soe"A94T <br /> 2 .04 -z0k -9I l -IL4 <br /> 3 . S- <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 tvienty-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 /> 1 -- January---------->March <br /> `�t Quarter - April ----------->June <br /> Quarter 3 - July ------------>September <br /> Quarter 4 - October --------->December <br /> Send to: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> yy4 f✓r n � �h n-.A . , P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 458-3420 <br /> EH 23 019 (10/89) <br />