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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />lacWty mambos •Gu,&' 1101!43fiVAIy/ lvS7i TY Ti d✓ <br />Task / S►se Product <br />.Z3S'vdr Kassa ✓ /'��— v o o <br />utility Addteaas (7a c <br />—; — i <br />Telephone: D - _A//y/ Ek. y,Z>D <br />Person Filing <br />Report V- <br />I hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were vithin the allowable limits for this <br />quarter. (No is Colum 13 of the Inventory Reconciliation Sheet) <br />Inventory variations exceeded the allovable 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) releaae. (Yes is Colman 13 of the <br />Inventory Reconciliation Sheet) I i <br />List date. tank /a and aasournt for all variations that exceeded the <br />allowable limits. <br />Date Tank I AmouoC <br />1. <br />4. <br />s. <br />e t. s, , , _ T s7;•uy To b� <br />0 0"4-� <br />Additioast daces/amounts chill be conCioued on a separaCe sheet of <br />Piper and arrached. <br />1f (hc aourcc of (he variation -h,ch c<cccdcd al luwblc Limits w s dui• to <br />a Luk the incident shall be reported to S.J.1..If.O. <br />Envsronmcntil Ilea lth <br />within 14. hours and ao unanchor i zed re leas, report submi Cted. <br />The Quarterly cu.. <br />y report shall be tubmiCted (hin IS days of the end of cacti <br />Quarte r. <br />Quarter I - January --) <br />QQaartcr Z - April --) Jun.- <br />Quartcr ) - July --) ]cp(cmhrr <br />Qrsrter G - October --) Ihcemhcr <br />Send Co: SAN JOAQUIN LOCAL HEALTH UISJHICT <br />1601 li. Hazellgul, 11.0 Nox 2009 <br />Stockton. CA 75201 *t*--6-}{y4- <br />Ur,1' 40 10/86 <br />0 <br />