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1 <br /> ti12 <br /> INVENTORY RECONCILIATION APR 10 IN <br /> QUARTERLY SUMMARY REPORT FOR„NVIRONMENTALHEA <br /> �I/7r <br /> PERM IT/I`,ERV,f--Z <br /> racility Name: ewz /GMS Aw.a Ar�/T Tank I <br /> Size Product <br /> Facility Address: ibo ti1afZ- ad AV-1r. E� <br /> Telephone : _„7o9 Aj3_ 9�S/ <br /> Person Filing <br /> Report _ ,e?1'11 Ss��Lonq <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 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 f Amount <br /> 1. <br /> �2. <br /> �/off 3. <br /> 4. <br /> Additional dates/amounts shall be core-:A - <br /> paper .and attached. <br /> If the source of the variation whichexceeded at'lowable 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 /> �uarccr 1 - January --> March . <br /> Qaa r c r -ri'—_- - � <br /> Quarter ) - July --> September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. IlazelLon P .O. Bos 2009 <br /> Stockton . CA 95201 466-6781 <br /> 40 10/86 <br />