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APR 14 1993 G /61 `1 <br /> INVENTORY RECONCILIATION CNVIRGIwMENT4L HV J <br /> QUARTERLY SUMMARY REPORT FORM PERMITISERVICE,�1.TH <br /> Facility. Naaet /,0j7-) Tank i Size <br /> Product <br /> Facility Wdrese: /0' 'd / d elex k CA X <br /> 1 <br /> Telephone : <br /> Person Filing �� <br /> Report /�Ccr»e SCOVI Ile <br /> nI 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 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 Column 13 of the <br /> Inventory Reconciliation Sheet) _ <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable lionits. <br /> Date Tank f Amount <br /> 1. 41 c' 3 / 4 6)4/ <br /> i. 2. c % -35� <br /> 3. 1-2 7 ICI — //q <br /> 4. ` `/ 6)_, - -f-' <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation whichexceeded allowable 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 unauthorized release report submitted. <br /> The Quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) Hirch <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --) [kcember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160 1 E . haze I < cin , I' . 0 . Box 2009 <br /> Stockton ,- CA 95201 466-61b1 <br /> ,T 40 10/ 86 <br />