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INVENTORY RECONCILIATION <br /> APR 2 2 1987 <br /> QUARTERLY SUMMARY REPORT FORM <br /> ENVIROMENTAL HEALTH <br /> ( FERMIT/SERVICES <br /> Facility Name: �1a� � S �tgc,�L�m tzUU� Tank i Size Product <br /> ,�//,� //�� B <br /> Facility Address: f7�� F rnitaev Ave- <br /> Telephone : q p(QGZ <br /> Person Filing <br /> Report [( ,wQ <br /> c „cl.: I_ <br /> Er1 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 I]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 /> was not due to an unauthorized (leak) release. (Yes in Column IJ 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 E Amount <br /> 1. A'A •, , , <br /> 2. <br /> ]. <br /> 4. <br /> 5. <br /> Additional dates/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 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 /> Q,,arter 2 - April --> June <br /> Quarter J - - July --> September •• <br /> Quarter 4 - October --) December 1\ <br /> Send to: (,SAN JOA QUIN LOCAL HEA1.1'1i WSTRWT <br /> 1601 E . Iazellon • I' .O R"X !0119 <br /> Stockton ; CA 95201 466 -67bl <br /> ur,•1. 40 1 ()/ 8() <br />