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INVENTORY RECONCILIATION JAN 17 1989 <br /> QUARTERLY SUMMARY REPORT FORM <br /> EN"QIONIVIFMIHEALTH <br /> c , <br /> PERMIT 'SERVICES <br /> Facility Name: La <br /> Tank I Size Product <br /> FkcitityUlddress: 11)1 7-el2AI <br /> Telephone : — <br /> Person Filin <br /> Report < <br /> �I hereby cert y 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 13 of 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 Colusm 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank I, and amount for all variations chat exceeded the <br /> allowable limits. <br /> Date Tank f Amount I , < <br /> I. <br /> 2. 2 4& -�#k" �M u1z81 <br /> 3. +0 J2171 JoE f0 <br /> 4. Y�'�TW\ work Dnl YES" <br /> 5. mg v�Tor �irlEs <br /> Pt�� ori )Z/7I�< <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper .and attached. <br /> It the source of the variation uhich. exceeded alllawabte 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 1 - January --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEAL1'li DISTRICT <br /> 1601 E. Hazelton . P .O. Box 2009 <br /> Stockton , CA 95201 466-6761 <br /> EH 23 019 10/86 <br />