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INVENTORY RLiCONCILIATION <br /> DAM <br /> Facly� qv QUARTERLY SUMMARY REPORT !CORM <br /> l , <br /> Namcl 1 <br /> So SEP 11 <br /> i991 <br /> Ino Tank � <br /> Facility Address , 1]26 E. Pine St <br /> roet Mfw1�l�8 l_IH ; <br /> _1 <br /> - (20 — 1 C_.--e--2-0-- - 1 <br /> Telephone! --- <br /> Person F 3 or 9 20 000 Diesel <br /> Reportl - 2 000 <br /> 2 000 eroson <br /> Solvent , <br /> I hereby certify under penalty of <br /> for the above mentioned facilityperjury that all <br /> this quarter , (No in Column 13were within the inventory variations <br /> of Che allowable limits for <br /> Inventory Reconciliation Sheet . ) <br /> ❑ Ipventory variations exceeded <br /> hereby certify under Llre allowable "'nits tion was not due to penally of perjury that the for this quarter. <br /> the Inventor unauthorized ( leak ) release, source for Che varia-I <br /> Inventory Recouciliatlon SheeL ) . (Ye_s in Column 13 <br /> of <br /> List date, Lank 1 , and amount for all variations that <br /> 1 the allowable limits . <br /> exceeded <br /> Date Tank <br /> 1 . Amount - <br /> 2 . <br /> 3 . - ----- <br /> 4 — -- -- — -------- — <br /> 5 . -- -------- <br /> Additional daces/amounts shall be <br /> Paper and aLtaohod. continu©d on n ao <br /> ParaLo ahuoL <br /> If the source of Lhe variaLlon <br /> due to a leak, Lhe i which exceeded allowable <br /> llenith DistricL; EnviroumenLalanealthreported within twenLls was <br /> ( 24 ) hours and an unauthorized reported to San Joaquin Local <br /> release <br /> report submitt Y-four <br /> The quarterly summary report shall be sub <br /> miCted within fifteen <br /> of the end of each quarter, <br /> ( 15 ) days ' <br /> Quarter 1 - January---------->March <br /> Quarter 2 - April------------ <br /> >June <br /> Quarter 3 - July-------___ <br /> '->September <br /> Quarter 4 0clobcr---_--_-- <br /> ->December <br /> Send Co; SAN JOAQUIN LOCAL <br /> HEALTH DISTRICT j <br /> 1601 E. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 466-3120 <br /> Ell 23 019 10/86 <br /> 1� (Ileke a o0 <br /> _ PY (velloW) for Klndt files and att <br /> . all tanks. ) --- —_ ___ ach Inventory Reo-- °`1lation reoorda for <br /> ----___ <br /> i <br />