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INVENTORY RECONCILIATION <br />JUARTERLY SURNARY REPORTF <br />FaciLLty Nam: . 'r <br />4c!9AICIFIC <br />• <br />ir"W',: <br />PersonTelephone: 02Q AL:i-3 <br />el hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable Huits for this <br />quarter. (No is Column 13 of the Inventory Reconciliation Sheet) <br />Inventory variations exceeded the allowable limits for this quarter. I <br />bereby certify under pecaity.of perjury that the source for the variation <br />was not due to an unauthorized (leak) celeise. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank i, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank 1 Amount <br />1. <br />2. <br />3. <br />4. <br />5. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which. exceeded at-lowabte limits was due to <br />a leak the incident shall be reported to S.J.L.H.D. Environmental lleatth <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 />Quarter 1 - January --, March <br />Quarter 2 - April --> June /! <br />Quarter I - July --> Septemher <br />Quarter 4 - October --> December It <br />Send to: SAN JOAQUIN WCAL HEALTH 015.1-RICT <br />1601 E. 1:azc l l i►Jt • P.O. BOX 2009 <br />• Stockton, CA 95201 466-61bi <br />.1(;1' 40 10/86 <br />