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F, <br />e <br />Facility !tame: <br />ONVENTORY RECONCILIATION 0 <br />QUARTERLY SUMMARY REPORT O. <br />Facility Addres a-. <br />,. <br />*R <br />Telephone.-,,,. /� ` j <br />r <br />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. (No in 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 an unauthorized (leak) celeise. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank f, and amount for all variations that exceeded the <br />allowable Limeics. <br />Date Tank l Amount <br />1. <br />2. <br />3. <br />4. <br />S. <br />JUL 23 1992 <br />HEALTHENVIRONMENTAL <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which. exceeded al-lowabte limits was due to <br />a Leak the incident shall be reported to S,J.L.H.D. Environmental licatth <br />within 24 hours and an unauthorized release rcporc submitted. <br />The quarterly summary report shall be submitted within 15 days of the end of each <br />quarter. <br />QuA rter 1 - January --, March <br />Quarter I - April --> June <br />Quarter 3 - July --> 'eptember <br />Quarter 4 - October --> December <br />Send to: SAN JOAQU IN LOCAL HEALTH U I S"1"K I CI" <br />1601 E. Haze I l c►n , P.O. BOX 2OO'3 <br />SLockcona CA 95201 466-67bi <br />LILT 40 10/86 <br />