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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility tdamc: <br /> Tank I Size product <br /> F:c ity Address: � � <br /> Telephone : <br /> Person Fili <br /> Report: l/,t <br /> hereby certifyunder <br /> penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> Quarter. (Ho in Column 13 of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable Kraits for thisuarte <br /> hereby certify under Penaltyof Q r' I <br /> was not due to an unauthorized (leak) release. (Yes uincColumnfor h3 ofrthtion <br /> Inventory Reconciliation Sheet) e <br /> List date, tank #, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank # tlinount <br /> i <br /> 2_ <br /> 3. <br /> TA HFALTH <br /> 4. <br /> Additional daces/amouots shall be continued on a separate sheet of <br /> Paper and attached. <br /> If the source of the variation which exceeded allowable limi <br /> a leak the incident shall be reported too <br /> S .J L. Ei . D. Environmental <br /> was 1 Ch <br /> s due e tt <br /> within 24 hours and an unauthorized r(•lease report submitted. <br /> The quarterly sumcaary report shall bar .ubmitted within IS d.ayy of the end Of (!.'ch <br /> quarter . <br /> Quarter 1 - Jaounry March <br /> Quarter 2 - April --> June <br /> Quarter 1 - July --> :;eptcmbr.r <br /> Ql,arter 4 - October --> fk cember <br /> Sen`' to: SAN JOAQUIN LOCAL HRALI.11 UISTELICT <br /> 1601 F.. Hazelton , P .O . Box 2009 <br /> IICT 40 10/86 Stockton , CA 95201 466-6781 <br />