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INVENTORY RECONCILIATION <br />QUARTERIJ SUMMARY REPORT FORM <br />114cWty Name: Llc4ucxa& Inc Tank <br />11rolduc t— <br />ate iie`" <br />3 Prem <br />TP) --bone. <br />Person Filing <br />Report __kelp <br />r tez - <br />quarter. iNo i a Co I <br />ke <br />hereby ce:'-t"fy "Ier '7efjury Okzt- the V4 1 tr <br />was 1r -?r efir !-a k:! (Leak) release. (Yes in Column 0 <br />laventory Reconciliation Sheet) <br />And amount for all variatioas <br />allowable limits. <br />Date Tank eructMR, <br />I q6 RECEI�EU <br />2. q0 .91OCT 9 10, 1O <br />3. q6 3 -e- ENVIRONVE14TAL HEALTH <br />4. PERMIT/SERVE ES <br />5. <br />-ou n t " 6 11 A L I be continued o n a a e p A r a t e f <br />paper and ACEached. <br />It Oe source ;4; rhe <br />C 0 <br />repc>S . j ;j <br />within 24 hours and an umautiturixed release report v,be:%cred. <br />TIv- qtiarterly summary report shji be submitted n v*thi15 dies of the end of each <br />quarter, 1 <br />Art - i I <br />J., , y --> <br />occober --) (),ccember <br />Send Co: SAN ,JOAQUIN 1,0CA1.1,HEA1,1-1-' DISTKICT <br />1601 E. Hazelton, P.O. Box Z0()9 <br />SLockt-on. CA 95201- 4-66-6761 - <br />I Ll(.;I' 60 10/86 <br />