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G <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility (lame: W Tank <br />acitit Address: <br />Person <br />Report <br />EA <br />Size Product <br />+1 I hereby certify under penalty <br />quarter.J"'W the above mentioned facility were within the- allowable limits for this <br />Reconciliationuan <br />variationsInventory <br />Reconciliationhereby certify under penalty of perjury that the source for the variation <br />vas not due to so unauthorized (leak) rele'ase. (Yes in Column 13 of the <br />Inventory <br />date,List <br />allowable limits. <br />Date Tank # Amount <br />I. <br />2. <br />. <br />4. <br />5. <br />Additional dates/amoucts shall be continued on a separate sheet of <br />paper and attached. <br />submitted.If the source of the' variation which. exceeded at -lovable limits was due to <br />m leak the incident shall be reported to S.J L.H.D. Environmental Health <br />within 24 hours and an unauthorized release report <br />The Quarterly summary report shall be xubmitted within 15 days of the end of each <br />quarte -r. <br />Quarter i - January --> March <br />Qjarter 2 - April --> June <br />Quarter 3 - July. --> September <br />Quarter 4 - October --> t>rccmber <br />SAN `JflAQUI1v 'ti)t. <br />' 1 <br />1601 E. Hazelton. P .0 , [lox 2009 <br />Stockton, C 95201 466-6761 <br />13i T• 1a0 <br />10/86, <br />