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i <br />INVENTORY RECONCIUTATION JAN 10� <br />QUARTERLY SUMMARY REPORT FORM- V<CNNY/E,'TAL11;r'-',4LTH <br />PERi1111 / SERVICES <br />FaciLity Name: <br />n" <br />FACWXY Address: <br />4 OEM <br />Telephone: <br />+ <br />i f <br />Person FWng <br />Report <br />ii <br />/ / <br />variationsof perjury that all inventory <br />variationsthe above mentioned facility were within the allowable limits for th--'= <br />0 Inventory <br />hereby certify under <br />was not due to an unauthorized (leak) rele1ise. (Yes in Column 13 of the <br />Inventory Reconciliation <br />date,List x f, and =mount <br />allowable limits. <br />Date Tank # Amount <br />2• <br />3. <br />4. <br />S. <br />Additional dates/amoucts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which. exceeded at'lowable limits was dust 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 sucKnary report shall be submitted within 15 days of the end of each <br />quartrr. <br />Quarter l <br />�, ..<. ede2 --AN` JOA U <br />`9 <br />- January <br />--> March <br />Quarter 2 <br />- April <br />--) Jure <br />Quarter 3 <br />- July <br />--> Septcmh<!r <br />Quarter 4 <br />- October <br />--> December <br />IN"LOCAL"" ' A AI:.i°[s `.�`1.S't' t,CT _.;. <br />1601 E, Haze l t 4)n , P.O. Bcox 2009 <br />Stockton, CA 95201 466-67b1 <br />W,i 40 10/ 8() <br />