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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORK <br />Facility Name: <br />Fac, ity Address: Gt3Z1 Tin i� <br />t, <br />Telephone: Oct <br />Person Filing -- <br />Report <br />I hereby certify under peaalt of <br />the above mentionedY perjury that all inventory variations for <br />facilitY were within the allowable Limits for this <br />quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br />QInventory variations exceeded the allowable Limits for this <br />quarter. <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to an unauthorized (leak) release. (Ye <br />Inventory Reconciliation Sheet) s in Column 13 of the <br />List date, tank %, and amount for all variations that exceeded the <br />Allowable limits. <br />Date Tank <br />Arsoun t <br />2. <br />3. <br />5. <br />ow C <br />P16CEI'VE <br />JAN 0 3 1992 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />Additional dates/aats shall be continued oo a separate sheet of <br />Cache <br />piper and atCCached.. <br />Lf the source of the variation which exceeded allowable lim <br />a leak the incident shall be reported to its was dui to <br />Within 24 hours and an unauthor' S.J.L.H.D. Its <br />llcaltt, <br />lease report submitted. <br />quarC��r. <br />The equarterly summary report shall be r,, submitted within 15 ""y; (It the end of <br />Quarter I - January --) Narch <br />Q•jarter 2 - April --> Juju• <br />Quarter I - July --> ScPtembe.r <br />Eartec . - October <br />--) (k`ccmber <br />-en(I to: <br />UCT 40 10/86 <br />SAN JOAQUIN LOCAI, 11LALT'11 DISTRICT <br />1601 E. Ilazelton, 1'.0. Box 2009 <br />Stockton, CA 95201 466_6781 <br />