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INVENTORY RECONCILIATION <br /> DATE: QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: F. Kludt & Sons, Inc. Tank I Size Product <br /> 1 20,000 UnI Plus <br /> Facility Address: 1126 E. Pine Street 2 20,000 R <br /> eoular <br /> Lodi, Ualifornia 95240 3 20,000 Diesel <br /> Telephone : -0 or G.66-8969 <br /> Person- g <br /> Report <br /> -I hereby certify under penalty of perjury that all in.entcry 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 /> 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 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2 I fVl �jl� hf <br /> 3. NOV g <br /> eN 1988 <br /> 4. vmo <br /> 5. <br /> �rS <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.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 --) Harch <br /> quarter 2 - April --> June <br /> Quarter 3 - July September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL_ HEAL'T'H DISTRICT <br /> 1601 E . Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> UGT 40 10/86 <br /> Make copy (yellow) for Kludt files and attach Inventory Reconciliation records for <br /> all tanks. <br />