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INVENTORY RECOIICIL IATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility t�amc: <br />Fac. ity Address: <br />LG se— <br />Telephone:�J� <br />Person Filing <br />Report A <br />h� <br />L hereby certify under penaltof <br />the above c�eationed facility were within ythe aallovablet all elim tsntoryvathons For <br />ar <br />quarter- (No in Column (3 of the Inventory Reconciliation Sheet) foris <br />ElInventory variations exceeded the allowable limits for this quarter. <br />hereby certify under penalty of perjury that the source for I <br />vs not due to an unauthorized (leak) release. the variacioa <br />a <br />Inventory Reconciliation Sheet). (Yes in Column 13 of the <br />List date, tank i, and amount for all variations that exceeded the <br />Allowable lio,i[s. <br />Date Tank I Aaouat <br />2_ <br />3. <br />4. <br />5. <br />R CEI <br />JAN 0 3 1992 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />Additional dates/amounts shall be continued on a separate sheet of <br />Paper and attached. <br />LE the source of the variati <br />leak the on which exceeded allowable limits was due to <br />Within 214 h <br />a incident shall be reported to <br />ours and an unauthorized release reporlt submiCtedonmental llealCh <br />T''c quarterly summary report shall brr srrbmi <br />Cr•r, CCcJ within IS play,, rpt Che rnc( of r <br />griar <br />..tch <br />Quarter I - Jauunry __) Harch <br />Q'iarter 2 - April <br />QuarCcr 3 - July <br />Tiar er . �. October <br />Scnrf to: SAN .JOAQUIN LOCAI, 11LA1.T11 UISThICI- <br />1601 F. 11aze l torr , f' . 0 . Box 2009 <br />LILT 40 10/86 Stockton, CA 95201 466-6781 <br />