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INVENTORY RECONCILIATION RECEIV <br /> M <br /> QUARTERLY SUMMARY REPORT FORM DEC 1 77n1991 <br /> raciLity Names �rI V Al lw l�ll�r�� Yank 1¢" IPA r wee <br /> P:cilityWdresss ��SL AF ( ;'LgDL� WA p` IL Lcper <br /> > 3�1 <br /> Telephone : (-0 , ) yZ/ <br /> Person Filing <br /> Report C y 0IV IU6 <br /> 0 1 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 is Column 13 of the inventory Reconciliation Sheet) <br /> Dlnvcntocy variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the veristioe <br /> was not Aue to an uaauthorixed (leak) celeise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date. tack /a and amount foc all variations that exceeded the <br /> allowable limits. <br /> Date Yank I Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> It 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 Hcalth <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be aubmittcd within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> Scpcemhaer <br /> Quarter - October --) Occembcr <br /> Send co: SAN JOAQUIN LOCAL HEALTI; DISTRICT <br /> 1601 L. Hazellun . P .O . Rax 2009 <br /> Stockton . CA 95201 466-67bl <br /> LH 23 019 10/86 <br />