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INVENTORY RECONCILIATION <br /> DATE: QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: E. F. Kludt & Sons, Inc. Tank t Size Product <br /> 120.000l Pus <br /> Facility Address: 1126 E. Pine Street 2 20,000 Reaular <br /> Ualifornia 95240 3 20,000 Riesel <br /> Telep <br /> Persne : (209) 36f3-063Q or L66-8969 <br /> on l n <br /> Report <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 13of the Inventory Reconciliation Sheet) <br /> DInventory 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 0, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1 PZV19974 <br /> 2. <br /> 3. Nov 411988 <br /> 4. ENVI (D1%'WNTAL HEgITH <br /> S. <br /> =R ?I'f/SERVICES <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and 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 .L .II .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 cacti <br /> quarter. <br /> Quarter 1 - 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. Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> UGT 40 10/86 <br /> Make cony (,yellow) for Kludt files and attach Inventory Reconciliation records for <br /> all. tanks. <br />