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• <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />APR 131989 <br />Facility Name� � E�i`Jif�h�f JM�NTAL hstA <br />Li H <br />-0�CES <br />ou <br />q <br />Facility Address: <br />IL �. <br />Telephone: Cd SZ OF <br />Person 7Z 2S <br />g <br />Repo t <br />L hereby ret fy under <br />the above penalty, of perjury _that ,ll inventory variations for <br />a+entioned facility were within the allowable limits for thin <br />quarter. (Ho in Column l3 of the Inventory Reconciliation Sheet) <br />QInventory variations exceeded the allowable limits for this hereby certify under is quarter. I <br />Penalty of perjury that the source for the variation <br />was not due to an unauthorized (leak) release. (Yes in Col <br />Inventory Reconciliation Sheet) eam7 13 of the <br />List date � <br />tank I, and =mount for all variation: that exceeded the <br />allowable limits_ <br />Date Tank E <br />— Amount <br />1. <br />2. <br />3. <br />4. <br />S_ <br />Additional dates/=mounts shall be continued on a r.eparate sheet of <br />Paper and attached. <br />I ','the• source of the variation which. exceeded allowable limits was due to <br />a leak the incident shall be reported to <br />Kithira 24 hours and an u�uthoriZed release _J . L • H . D _ Environmental Health <br />e report submitted. <br />The quarterly summary report shall <br />quartcr_ be submitted yithin 15 days of the end of <br />each <br />Quarter I - January --) tlarct, <br />Qiarter 2 <br />Acral --) June <br />Quarter I - J-ul <br />Quarter L Y u- <br />--> Srptcmt <br />_ r <br />October --) December <br />Seod to, <br />SAN _l OAQU I N LOCAL HEALTH D I ST11 i C 1- <br />1GO 1 l:. 1::,zc• J t ��» , l' . 0 . l,Ox lrxly <br />�.O 10/86 Stockton_ (.A '!5"201 466-07b1 <br />lrrZ' <br />w <br />