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INVENTORY ['l E E <br /> i e <br /> RECONCILIATION OCT E ral <br /> 2 2 1992 <br /> QUARTERLY SUMMARY REPORT FORM _ E(wV1RON1V1EN-iALr-;t:Aw.iH _ <br /> PERN11-u SEF)vi- <br /> Facility. Names —)qm /pm 2/UTank f Sise. <br /> Product <br /> Facilit 'Address: iO oDC� <br /> -,Y .. �3�/� i✓ CLz/ <br /> JOc f fCn Cly 9��C L/ o©o a e <br /> Telephone : c <br /> Person Filing <br /> Report Toch /-)e <br /> ❑ I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (Ho in C-1.,= 13of the ln.catory lZecoliciliation 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 /, and amount for all variations that exceeded the <br /> allowable licnits. <br /> Date Tank f Amount )t IrIOA 012- 7/ZZ/�/Z <br /> 1. 3 CjZ / *//J' Y�po LCcE�e � - <br /> 2. � � �i i / t 90 <br /> 3. <br /> 02 <br /> 13 V <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> raper z3d 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 --) March <br /> Quarter 2 - April --) June <br /> Quarter 3 - July --) Septcmb(-r <br /> Quarter 4 - October --) (}ccember <br /> Send to: SAN JOAQU IN LOCAL HEALTH U I STK ICf <br /> 160L E . I;aze 1 L o�n , P . O . lacy 2009 <br /> Stockton ,- CA 95201 466-67b1 <br /> t:T 40 10/86 <br />