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41 eljl. <br />a <br />NVIN,TOR:Y RECOKC1LIATt©.N it4'tk6 <br />a <br />QUARTERLY SUMMARY ,REPORT fQRM _ 4„ <br />aciuty games Flame Liquo sC 'lw . Sive- SrQdu St <br />}y. <br />tacitLty •Addritea: O9 i� eet 8i1L$ile <br />' <br />z <br />� <br />I.414 wx tS o ao Prom <br />—77 <br />Telephone: <br />Al <br />Pex on Piling <br />ReportPate <br />{ <br />. <br />�f.. .. <br />> -hereby certifywad er pen alty ofperjury that all inventory variations for <br />pry <br />:., <br />the above ftentid facjlit t,'were' iri,tliita,-the allowable' limits for chis <br />gnsrter. { o la Column 11of the lQ*,4 ory , Motion Sheat) <br />n <br />hciveatarry mar t i,,oas c*lc eedoO - thet *I, -I w to � t Iwif4s, for tbls gwster. i <br />.. <br />hereby cert* pe", lt , Of porjiw t tto; oo, "a for the variation <br />was not due to 00 aut d m _ ktl ' *,P In, Column 13of the <br />. <br />Inventory 1Gec a'liatoat�, <br />wr .' <br />' <br />List data t teak #j end verioto** that exc ed the <br />allowobie l 01ta. ' <br />�s <br />Date �l"s. /Amount <br />4 <br />2. VEL` <br />b <br />t +F <br />7 <br />M <br />e rfttt <br />d <br />! <br />4m <br />1 <br />Av <br />+r <br />iq <br />CC <br />µe <br />Additional d*teo/amouatx shalt be continued on a separate sheet of <br />r <br />paper and attached., <br />If the source of the variation which.exceedeed allowable limits vas due to <br />a leak the incident shall be, rt4poct.ed to S.J.L.M.D. Environmental Health <br />4 <br />within 24 hours and an unauthorz'ted releAse report submitted. <br />'. <br />The quarterly suamaryt report shall be submitted within 15 days of the end of each <br />t: <br />--� <br />Quarter 1 - .Dat�uary March <br />, <br />Qsarter 2 �- April Juno <br />Quarter 1 - July --•? Septeapher <br />. <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL HEALTH UISTRIC"1' <br />1601 K. Hazelton. P.O. BOX 2009 <br />SLock'ton, CA 95201 466-67b1 <br />X, <br />tf.GT <br />40 10/86 <br />s <br />T <br />