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JUL 10 1989 <br /> INVENTORY RECONCILIATION <br /> ENVIRONMENTAL HEALTH <br /> QUARTERLY SUMMARY REPORT FORM nEgnn!TJ Pp <br /> Facility Name: CAQL haQ �rt1�1 Tank i <br /> -- Size Product <br /> Facility Address: aQ_1WF4-L0pJ AJ,F �s6L <br /> Telephone : ��3-rq7 <br /> Person Filing <br /> Report <br /> I hereby certify under penalty of perjury that al inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Column 13of the Inventory Reconciliation Sheet) <br /> ElInventory 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 /> ��. <br /> I V 3. <br /> 4. <br /> S. <br /> Additional daces/amounts shall be continued 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 summacy report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --> March . <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . liazelcon , P .O . Box 2009 <br /> Stockton , CA 95201 466-67b1 <br /> 'I;T 40 LO/86 <br />