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RE <br /> INVENTORY <br /> INVENTORY RECONCILIATION JAN 16 1992 <br /> QUARTERLY SUMMARY REPORT FORM ENVIRONMEN0'I- 7H <br /> PERMIT <br /> Facility Name: Tank i Sise Product <br /> E� <br /> facility Address: 09Do -14,e4taAl fh/!� .2 S o <br /> wlffivr feW GA • 9�'33b <br /> Telephone : „209- X53- 9�5/ <br /> Person Filing <br /> Report ,8////eiz/.0 <br /> ® I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility eerie 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 i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> �2. <br /> / /0"f' 3. — <br /> 4. <br /> 5. <br /> Ante-,'amll <br /> auv'.s :+..a.a Le c®ncinuee on a separate sheet of <br /> paper and attached. <br /> If the source of the variation whichexceeded 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 1 - January --> March . <br /> Quarter 2 - April --> June <br /> Quarter 3 - Jul --> Septemhcr <br /> Quarter 4 - October <br /> Send to: SAN JOAQUIN LOCAL HEAL1'li DISTRICT <br /> 1601 E. Hazelton ,- P .O . Box 2009 <br /> 40 10/86 Stockton . CA 95201 466-6761 <br /> " <br />