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g - <br /> INVENTORY RECONCILIATION " � `=� �� IV <br /> ED <br /> QUARTERLY SUMMARY REPORT FORM 7 t8 1991 <br /> ENVIRONMENTAL HEALTH <br /> Facility Name: eAd Tank I Size ProAuct <br /> Facility Address: R)0 -/-1F,c40A/ A/d�7 � Er <br /> S o <br /> �?ftvr>FG4. GA 9s�36 <br /> Telephone : ;20 - J0,03 9�S/ <br /> Person Filing <br /> Report ; ?/// <br /> El <br /> /yJ/Lo7y9 <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 IJ of the Inventory Reconciliation Sheet) <br /> 0 Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> van Got due to so unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> �2• _— <br /> �D ]. <br /> 4. <br /> 5. <br /> Additional dates/amouots shall be continued on a separate sheet of <br /> paper and atcached. <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 42YS of the end of each <br /> quarter. <br /> Quarter I - January --> March . <br /> Quarter 2 - April --> June <br /> atter ) - July _> ye�>pte h <br /> atter 4 - October --> ee <br /> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTK1CT <br /> 1601 E. IlazelLon ,- P .O . Bos 2009 <br /> Stockton . CA 95201 466-6761 <br /> 40 10/86 <br />