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4 V <br /> i"V E D <br /> INYENTCRY RECONCILIATION APR 10 1^001 <br /> QUARTERLY SUMMARY REPORT FORK ,0'N`ALHEALTH <br /> PF.RM'11'/St R'JICB: <br /> Facility Name: Tank <br /> Size Prod•Lul <br /> ct <br /> �2LLy �cL 9�s�t 4 <br /> Telephone ; <br /> Person Filing <br /> Report �1 <br /> i <br /> I hereby certify under <br /> penalty of perjury that all nrentory variations for , <br /> the above mentioned facility were within the allowx.':.le limits for this <br /> quz-tcr. `Ho in Columxa . d the Inventory Reconci/. .ation Sheet) <br /> I <br /> Q 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 /> 1 Inventory Reconciliation Sht !t) <br /> List date, tank 1, and amount for all variations chat exceeded the <br /> allowable limits. <br /> f <br /> Date Tank f Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amouars shall be continued of a separate sheet of E <br /> paper and attached. <br /> If the source of the variat-, i which. exceeded al-lot.;,bLe limits was due to <br /> a leak the incident shall be reported to S .J .L.H . O. Environmental Health <br /> wiChin 24 hours and an unauthorized release report submitted. <br /> t <br /> The quarterly summary report shall be xubmitted within days of the end of each f <br /> quarter. E <br /> Quarter I - January --> March <br /> Quarter 1 - April June <br /> Quarter 3 - July --> Septcmh(-r Ij <br /> Quarter 4 - October --> Occember <br /> t <br /> Send to: SAN JOAQ'J I" LOCAL HEALTH U I STI. iLCT I <br /> t <br /> 1601 E. liaze 1 t<,n , P .O . Box 2OW.' <br /> Stockton , CA 95201 466-6761 <br /> EH 23 019 10/86 <br />