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e <br /> 9 <br /> LNVI NTORY RECONCIhI.ATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Fars i I i Ly Name• T l_ONESTAR Tank N Size VroducL <br /> -- -- -- --_.l —I;UUII-- inI e a de <br /> Facility Address: 30350 S . T :•acy Blvd . -- 2 10 000 Diel <br /> - r, tc.y j---r,R.. �3�r, _ __.- .. : ___---- ie- <br /> T e t /111 a n e <br /> Vernon t-i - <br /> ReVo r. t : Lt_«yU S . BURNS ---- - <br /> i <br /> - I hereby certi 7y •antler penalLy of perjury LhaL all inventory variations <br /> [M- the above ir.ev ni.oned facility were within the allowable limits for <br /> this quarter Wo in Column 13 of the Inventory Reconciliation Sheet . ) <br /> ) <br /> j i "VenLory var nkioncs exceeded the allowabte limits for this quarter . 1 <br /> lu.:reby cerci :ender penalty of perjury that Lhe source for the varia- <br /> _� L ion was 50L L10 to unauthorized ( teak ) release. ( Yes in Column 13 of <br /> I.hn Inventory Penonci .l.i aLion Sheet ) . ---- <br /> i <br /> L� sL dat;",. Lack N , and amount for all variaLiuns Lhat exceeded <br /> the s.I.UM/i ble 3 jo ti . <br /> Pa Le Tank -# Amount � <br /> CEIVED <br /> 4 . <br /> _____ENVW0N MENTAL HEALTH <br /> cR ITHERVIC <br /> A1d i Li Uc Q atcs/amounts shall lac conLi.nued on a separaL•e sheoL <br /> I'oper u: t re nct"hud . <br /> If the sourc o , )l the Variation which exceeded allowable limits was <br /> duo Lo a ? `•ak 0t incident: shall he reported Lo San Joaquin Local <br /> JwAlth UisLric: L; Wvi ronmental Ileal.Lh I).ivi.sion; wi.Lh.i.n Lwen►Ly-four <br /> t � ) IIOIIrh ilrl(} al'1 ittlau( hori zvd release r eporL submitted . <br /> i <br /> The (Ino . t.er 1 y, s11•.;onry .report shall_ be submiLLed wiLhi_n fif Leen ( 15 ) clays <br /> of Lhe end of each 1"ar'_er . <br /> January------------->March <br /> ) <br /> duty------------->ScpLember <br /> Quiiut-w 4 - OcLuber---------->Decembe.r <br /> send t o: 1AV JOAQUIN LOCAL HEALTH DISTRICT <br /> Hazelton, P.O. Box 2009 <br /> t+torkt:on, CA 95201 460-3420 <br /> t <br /> �IrEN: JAIME FAVILA <br /> 1,11 11 0 i '1 1 ()/86 " <br /> �t l 7 <br />