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HE CE I VE D <br /> � INVENTORY. RECONCILIATION <br /> .00T 2 <br /> d} 1991 QUARTERLY SUMMARY REPORT FOR <br /> � Tank AE9i \�r �� N Cn1�c t, e duct <br /> FLf <br /> Facility Address: QW4..44 c oo <br /> _Gac ntin r_onCGRY '2 Oo o <br /> Telephone: 2057 S.EL DORADO - o COD <br /> Person Filing N(209)4%W10 <br /> Report: <br /> I hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (Ng in` column 13 of the . <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in Column 13 of the Inventory Reconciliation <br /> Sheet) . <br /> List date, tank , amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank I Amount Reason <br /> 1. <br /> 2. <br /> 3. <br /> 4 . <br /> Additional dates/amounts shall be continued on a separate <br /> sheet of paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Services of San Joaquin County Environmental Health <br /> Division, within twenty-four (24) hours and an unauthorized <br /> release report submitted.- <br /> The <br /> ubmitted:The quarterly summary report shall be submitted within fifteen (15) days of <br /> the end of each quarter. Circle appropriate quarter. <br /> Quarter 1 - January---------->March <br /> Quarter 2 - April ----------->June <br /> Quarter 3 - July ----4 4� ---->September <br /> Quarter 4 - October --------->December <br /> Send to: SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> BOX 2009Q <br /> Stockton, CA 5201 GASA DGROCERY <br /> (2 09) 468-3420 2057 S.EL DORADO <br /> STOCKTON(209)465.8210 <br /> t ' 9 <br />