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"' <br /> .> in <br /> OD <br /> HE%JO im <br /> INVENTORY RECONCILIATION JUL 1 1991 <br /> QUARTERLY SUMMARY REPORT FORMENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> Facility. Name: „��% 4ii���u ,c c <br /> P Tank Size Prcr:uct <br /> Pac£lity'Wdress �( •/ 7 /B,cu4 o C � <br /> Telephone -. 9s-l-r&f/ <br /> Person Filing <br /> Report C>2 ,_✓ �, L <br /> E] 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. (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) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1• .3l4/ / /9! urs <br /> 3. 6,111/ 9/ ;7_ 02 6 y vv 4. S!S 9/ '7 <br /> s. -r/'z 4191 <br /> Additional dates/amouats shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded at'lowable 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 Quarter4y summary report shall be submitted within 15 days of the end of each <br /> Quarter. <br /> Quarter 1 - January --) March <br /> 111 .garter 2 - April --> June <br /> Quarter 3 - July --> Scptemh':r <br /> Quarter 4 - October --> 0-ccember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. liaze 1 Loll . P .O . Box 2009 <br /> Stockton . CA 95201 466-6761 <br /> EH 23 019 10/86 <br />