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• RECEIVED <br /> INVENTORY RECOttCIL lATiON ,IAN 17 1992 <br /> QUARTERLY SUMMARY REPORT FORMENVIRONMENTAL HEALTH <br /> Facility Namc: r ++% PERMIT `' iCES f�JUt �T� �S Tank I �. <br /> Product <br /> Fac . icy Address: /S�c� W t/t/) /OCAL"o <br /> Telephone c,, <br /> o v u <br /> Person Filing <br /> Report b � <br /> ❑ I hereby certify under penalty of perjury that all inventory variations <br /> the above mentioned facility were within the allowable limits for this for <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) release. (Yes in Colin 13 of the <br /> Inventory Reconciliation Sheet) —' <br /> List date, tank i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank Amount <br /> t. _ 3 yo <br /> 3. -- <br /> 4. <br /> 5. <br /> Additional daces/amounts shall be conti <br /> Paper and attached. nued oo 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 S .J .L. LI. D. Environmental lfealth <br /> Within 2/* hours and an unauthorir.ed rolcasc report submitted. <br /> The quarterly sucaaary report shall b,! s4ibmi <br /> g1iarcer , [tcd within IS tf,lys ot the end of each <br /> Quarter ( - Jaounry --) "arch <br /> Qiactcc 2 - April <br /> QU a rte <br /> r- }.___-= Jury --) :;c��tcmbrr <br /> T .lctec 4 - October --> 01Ccember <br /> Send o SAN JOAQUIN LOCAL. ILS S ' <br /> HEALTH UI�'IhIC1' <br /> 1601 F.. L(azeItof, , L' . 0 . Box 2009 <br /> 11CT 40 10/86 Stockton . CA 95201 466_6781 <br />