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'D:' r d. t <br /> i <br /> APR 2 0 1992 <br /> INVENTORY RECONCILIATION ::NVIRONMENTQL HEAL-r[-6 <br /> QUARTERLY SUMMARY REPORT FORM N�h� II�/ Ck1vi�!~ <br /> Facility Name; 4zalongAi,iAlom,ej6Ar*6o&x. Tank i <br /> Size Product <br /> facility Address; <br /> LIWLTelephone : .�,t�o� _ 005 <br /> Person Filin <br /> Report <br /> hereby certify under penalty of perjury that all inventory <br /> 'he above mentioned facility were within the allowable limsvforathis' for <br /> quarter. (No in Column 13of 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 so unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable lia,its. <br /> Date Tank E 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 /> i <br /> Lf 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 . Env i ronmenta L 11ca l C h <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly sumaary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March <br /> Q.AArtcr 1 - April --> June <br /> Quarter 3 - July --> Septemhr.r <br /> Q�.aceer 4 - October --) lkcember <br /> Send to: SAN JOAQU I N 1.0CAI. HEA1.1'1i DISTRICT <br /> 1601 I: . Haze l t ern , 1' . O . 11ox 2U0g <br /> Stockton , CA 95201 460 -67b1 <br /> ;1' 40 10/ 86 <br />