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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> [acility Namet 6 6 Tank 1 Size I Product <br /> v UoO ,eP <br /> facility•Addrenat <br /> Telephone : KDe)q) <br /> Person Filing._ <br /> Report 444"' / <br /> N DT �DmPcsry cJSTIJ�.SF£ .S£/'b s+E. R 4 <br /> ElI hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the ■llowab W limits for this <br /> Quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> Ej---�Inveotocy variations exceeded the allowable limits for this Quarter. i <br /> hetaby certify under penalty of perjury that the source for the variation <br /> was no[ due to an unauthorized (leak) releise. (Yes in CoLumma13 of the <br /> Inventory Reconciliation Sheet) _Jo, .a"/ ' t <br /> .� ten-.,r% : .PPS �:...x. L, <br /> List date, tank 1p and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount Oh7� /�-W7 <br /> 1. /o� / / z //�zt / /oS <br /> 3- /tel i 3 Z- <br /> 4. <br /> 4. ! z8 i l° i/zl 3 i3 <br /> S. 10/ Z 2- /S a/z3 3 13 <br /> z/x z 1 8 <br /> Additional dates/amouats 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 unauthorised release report submitted. <br /> The Quarterly summary report shall be submitted within 15 days of the end of each <br /> Quarter. <br /> Quarter I - January --5 March ' <br /> Quarter 2 - April --> June APR 14 1988 <br /> Quarter 3 - July --> September <br /> steer 4 - October --> fkcember /�B`I ENVIROMENTAL HEALTH <br /> PERMIT/SERVICES, <br /> Send to: SAN JOAQUIN LOCAL HEALTH U1S'1'K1C'r <br /> 1601 1:. (laze 1 t011 • 1' .O . Hos 2009 <br /> Stockton . CA 95201 466-67bl <br /> LILT 40 10/ 86 <br />