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INVENTORY RECONCILIATION <br /> Q%--. TERLY SUMMARY REPORT FORM <br /> C <br /> FaciLicy Name: -�9� Tank f Size <br /> coduct <br /> Facility Address: <br /> Telephone : <br /> Person Tsling <br /> Report <br /> C] L 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 allovable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas not due to as unauthorized (leak) releise. (Yes in Column 13 of the <br /> Iaveatory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations Chat exceeded the <br /> allowable limics. <br /> Date Tank f AmountRFM"1 '*` <br /> V :: <br /> z. JUL 16 190. <br /> 3. ENVIRONMENTAL HEALTH <br /> 4. <br /> PERMIT/SERVICES <br /> S. <br /> Additional daces/amounts shall be continued on a separate sheet of <br /> paper .and attached. <br /> [f 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. Environmental Uczlch <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 /> Qu4rrc r 1 - January --) March <br /> giarter 2 - April --> June <br /> Quarter 3 - July --) ScpCcmh.!r <br /> Quarter 4 - October --> lk cember <br /> Send co: SAN JOAQUIN 1.0(:Al, HEALTH UIS'I'KIC'1' <br /> 1601 E. Haze 1 ton , 1' .0 . Box 2009 <br /> SLockcon . CA 95201 466-6761 <br /> 11(.T 40 10/86 <br />