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p �L <br />� ro <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORK ENVIROMENTAL HEALTH <br />F ERMIT/SERVICE <br />x Flame Liquors IrrE <br />lacility,'Addcesss 1301 W. Kettleman Lane <br />Telephone: (292) 334-3233 <br />Person Filing <br />Report Pete Graffigna <br />mm , MM -PTIM <br />El I hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />quarter. (9 is Column 13 of the Inventory Reconciliation Sheet) <br />® Inventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to as unauthorized (leak) releaso. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />a <br />List date® tank i® and amount for all variations that exceeded the <br />allowable limits. <br />DateTankTank f Amount <br />1e <br />aan 8/ 1 <br />2. Jan 87 G <br />3. Jan 87 <br />4. <br />5. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper snd attached. <br />If the source of the variation which. exceeded at-lowable Limits was due to <br />a Leak the incident shall be reported to S.J.L.H.D. Environmental Health <br />within 24 hours and an unauthorized release report submitted. <br />The quarterly summary report shall be submitted within IS days of the end of each <br />quarter. <br />Quarter I <br />- January <br />--> <br />March <br />Quarter 2 <br />- April <br />--> <br />June <br />Quarter ) <br />- July <br />--> <br />September <br />Quarter 4 <br />- October <br />--> <br />December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. liaze 1 L e►n . 11.0. Rex 2009 <br />Stockton, CA 95201 466-6761 <br />IICT 40 10/86 <br />