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INVENTORY RECOtICILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Na©.: G)-;k -A— #� 13 Tank I <br /> Fac. ity Addreae- Size Product <br /> 3�SS c� /v o <br /> �cciZ L.� <br /> Telephone : GnCd US-ted <br /> Person Filing 3��=— <br /> Report: �� GG� ti <br /> L hereby certify under Penaltyof <br /> Perjuthe above mentioned facility were withinytheaallowablecntorlim tsall iyvarfor3this$ for <br /> quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the aLlovable Limits <br /> hereby certify under penalty for Chis quarter.perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (Y <br /> Inventory Reconciliation Sheet) es in Column 13 of the <br /> List date, tank 1, and amount for all variations chat exceeded the <br /> aLlovable limits. <br /> Date TankArco IVE D <br /> unt <br /> I- JAN 0 3 1992 <br /> 2- LNVIRONMENTAL HEALTH <br /> 3. — PERMIT/;FRVIr,ES <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be conti <br /> Paper and attached. nued oo a separate shoe[ of <br /> Cf the source of the variation which exceeded allowable limits was due <br /> a leak the incident shall be reported to Co <br /> Within 24 hours S .J . L. II. D. Environmtental ticalttt <br /> and an unauthorized rolease report submitted. <br /> The quarterly suc—ary report shall be submi <br /> gIAarcer . �•�f t[ within IS "-'Y.'; ot Che end of each <br /> Quarter I - January --) Harch <br /> (',Narter 2 - April --> June <br /> Quarter - July __) <br /> Sc1)Cem6r.r <br /> �arccc,� October -_) f)t.Cemher <br /> Srnfl to: SAN .JOAQUIN LOCAL 11EAI_1•11 DISTRICT <br /> 1601 E. Hazelton , 1' .0 . Box 2009 <br /> (ICT 4010/86 Stockton. CA 95201 466-6781 <br />