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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM HuFLTH <br /> t ENVIROMENTAE <br /> SE'itVICcS <br /> Facility Haatet Tank I Stse Product <br /> Facility Addre.at <br /> Telephone : <br /> Person Filing <br /> Report �l ( <br /> i <br /> I hereby certify under penalty of perju that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> Quarter. (No in Colum I3of the loventocy Reconciliation Sheet) <br /> ❑ Inventory variations exceeded the allowable limits for this quarter. t <br /> hereby certify under penalty of perjury that the source for the variation <br /> was cot due to an unauthorized (leak) release. (Yea is Column 13 of the <br /> Inventory Reconciliation Sheet) f ' <br /> List datew tack ft and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 2. <br /> 4. <br /> S. <br /> AddiCiooal daces/a uots chs p be continued on a separate sheet of <br /> Paper and aCCachcd. <br /> ff the Source of Chc variation ..h.ch cxc,-cdcd allowable limits w s due Co <br /> a luk the tnctdenc shall be rcpor ecd to S , J 1, Ii U . Envi ronmcntaI Ilea It <br /> wtthkn 24 hour, and an unauthor . rrd rt- base report submitted. <br /> the Quarterly a..m ry report shall be c..bmi(ccd wichtn 15 days of (he end of each <br /> quar (rr <br /> Quarter i - January --> March <br /> Q.artcr 2 - April --) J. "'. <br /> Quarccr ) - July --) ;Cp(r.her <br /> Q..artcr - October --) D,. ccmhcr <br /> Send co: SAN JOAQUIN 1.0CA1, HEA1,11; OISIVIC'1' <br /> 1601 K . 1!ar(• I1 .af , P . O Ko.x 211f)') <br /> Stockton . CA '15201 1,00 - 67bl <br /> Uf;T 40 IO/ K4 <br />