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INVENTORY RECONCILIATION /�/�� <br /> QUARTERLY SUMMARY REPORT FOUL 12 1991 <br /> tNViRONMENTAL HEALTH <br /> Facility Name: eAez &M'f,EIE,Q 'r.,7- rAiAwT T I F77r1LW— Product <br /> Facility Address: Jbo -H1E'C40A1 A Er <br /> S o <br /> 1`?�ryrFcfJ. GA 9��36 <br /> Telephone : ;209 ?.-'�3- i:,l5/ <br /> Person Filing <br /> Report ,8�%/ N1/L 07>9 <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 IJof 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 as 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 /> I�okol( �. <br /> 4. <br /> 5- <br /> Additional dates/amounts shall be continued an a ccpa:ate r;,eet of <br /> paper ind 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 .1. . 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 - Jan airy March . <br /> saner 2 - April <br /> --) June ; <br /> Quarter ) - July --> September <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton P .O . Box 2009 <br /> Stockton , CA 95201 466-6761 <br /> ,0 10186 <br />