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lvbk�pL22uu4u <br /> JAN 5 5989 <br /> INVENTORY RECONCILIATION ENVIRONMENTALIHESLTH <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: L441- k4x('w42 FNr Tank i Size Product <br /> Facility Address: Re4 &Veb L-nAi 'qkE L Z <br /> /1'1.4.v7`EG� GA 9/J3/ <br /> Telephone : X209- f123— 9,Z 5/ <br /> Person Filing <br /> Report (j/LL L;1/LO/,9 <br /> E] 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 /> 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 I Amount <br /> 1. //-3 .A o £In <br /> a�Gi <br /> 3. 3 �+ G 00) <br /> 4. 7 rp <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 I - January --) March . <br /> Qiarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> a rtcr 4 - October -- •cembcr <br /> 19 re, <br /> Send co_ SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton , P . O . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> UGT 40 LO/86 <br />