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Facilic; <br />Facilst; <br />Telepnc <br />Person <br />Report <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />QI 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. (No in Column l3 of the Inventory Reconciliation Sheet) <br />_ M <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 an unauthorized (leak) release. (Yes in Colum 13 of the <br />Inventory Reconciliation Sheec) <br />List date, tack i, sad amount for all variations that exceeded the <br />allowable licnics. <br />Date Tank f Amount <br />t. <br />z. <br />3. <br />4. <br />s. <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />Lf the source of the variation which. exceeded allowable limits was due to <br />a leak the incident shall be reported to S.J.L.H.D. Environmental Heat ch <br />Within 24 hours and an unauthorized release report submitted. <br />The quarterly sum:aary report shall be submitted within 15 days of the end of each <br />quarter. <br />Send Co: <br />tICT 40 10/86 <br />Qu:.rtcr <br />1 - January --> March <br />Quarter <br />2 - April --> Julie <br />Quarter <br />3 - July --> September <br />Quarter <br />4 - October --> D-cember <br />a <br />. - <br />SAN JOAQUIN l.0(:AI® HEALTH UISTKICI !+` <br />r" <br />160L K. Haze 1 t <+n P.O. <br />fl./> d73 <br />Liam 2009 <br />. <br />SLockeon. CA 95201 <br />466-6781 <br />� <br />