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RECEIVED <br /> INVENTORYRECO11c1L IATION APR 15 1991 <br /> QUARTCRLY SUMMARY REPORT FORM ENVIRONMENTAL HEALTH` <br /> Fac il i t' K <br /> — "U, - Tank I <br /> Size Product <br /> Fac. ity Address: r <br /> Telephone <br /> '1 t <br /> Person Fi ng <br /> Report ' <br /> QL hereby certify under penalty of perjury that all inventoryvariation <br /> Cb" above mentioned facility were within the allowable limit <br /> for this$ for <br /> quarter.. (Ho in Column 13 of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable limits for this <br /> hereby certify under penaltyof quarter. I <br /> was not due to an unauthorized (leak) release. (Yes e souineColumn 13 offor therthCion <br /> Inventory Reconciliation Sheet) <br /> the <br /> List date, tank #, and amount for all variations that exceeded the <br /> Allowable limits. <br /> Date Tank # Amount <br /> 2- <br /> 3. <br /> 4. <br /> S. <br /> Additional ch <br /> Paper and attached. Ots shall be continued on a separate sheet of <br /> If the source of the variation which exceeded allowable limits was due to <br /> a leak the incident shall be reported to _ <br /> Within 24 hours and an unauthorized rc�lcase J .L.report Dbmittcronmental licalth <br /> The quarterly summary report shall be submitted within 15 ti.ays of the end of <br /> quarter . <br /> Quarter 1 - January <br /> Quarter 2 - April --> June - <br /> Quarter 3 - July --> 5eptem1wr <br /> Q„acter 4 - October --> 1)ecembcr <br /> .•end to: SAN JOAQUIN LOCAL HEALTH DISTRIC1' <br /> 1601 E. . Hazelton , P .O . Box 2009 <br /> IiCT 40 10/$6 Stockton, CA 95201 466-6781 <br /> _ <br />