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7 <br /><_ <br />' oil <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />let <br />Facility Name: �/��'�4 <br />i Tank at Size Product <br />1Pac£Lity Address: <br />Telephone: CA I•. <br />Person F ng <br />Report <br />I hereby certify under renally of perjury that all inventory variations for <br />the above mentioned perjury <br />werewithin the allowable limits for this <br />quarter. (No in Column l3 of the Foveatory Reconciliation Sheet) <br />ElInventory variations exceeded the allowable limits for this Quarter. x <br />hereby certify under penalty of perjury that the source for the variation <br />vas not due to an unauthorized (leak) releise. (Yes in Colum <br />Inventory Reconciliation Sheet) n 13 of the <br />List date, tank 1, and amount for alL variations that exceeded the <br />allowable liatits. <br />Date Tank I Amount <br />2. <br />3. <br />4. <br />5. <br />Additional datesiamouats shall be continued on a separate sheet of <br />Paper and attached. <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.H.D. Environmental Health <br />Within 24 hours and an unauthorized release report submitted. <br />the Quarterly summ,ry report shall be Kubmitted within 15 days of the end of each <br />quarter_ <br />Quarter / - January --, Hirch <br />Q�marter 2 - <br />April --> June <br />Quarter l - July ---> scptcmhcr <br />Quarter 4 - October --) December <br />Send to: SAN JOAQUIN LOCAL HEALTH UIS -1 -HILT <br />1601 E. 1'.aze l t imte . P.O. li()x 2009 <br />t1t:T LO 10/86 Stockton, Cil 95201 466-6761 <br />