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INVENTORY RECONCILIATION <br />Q � E o aw <br />QUARTERLY SUMMARY REPORT FORM •, AtALTl. <br />Fac i lit kRN1 PT/GERVICES <br />� lamC <br />Fac ity Address: <br />4y.1; <br />Telephone : y _ 36 -73 7.1-- <br />Person <br />1Person iling ---- <br />R e p o r t �2 r7� of 45 a< < � ...•� <br />I hereby certify under penalty of perjury that all inventory variations <br />the above mentioned facility were within the allowable limits for this for <br />quarter. (No in Column 13of the Inventory Reconciliation Sheet) <br />❑ Inventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to an unauthorized (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) —' <br />List date, tank I, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank I A=uut <br />2- <br />3- <br />4. <br />.3_4. <br />5. <br />Additional dates/amounts shall be continued on a separate sheet of <br />Paper and attached. <br />IE the source of the variation which exceeded allowable limi[s 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 submiCted. <br />nle quarterly sucaaacy report shall t)4, <br />quarcf-r. :ubmit[rc1 within IS l.iy;: of Che end of c-,ich <br />Quacccr I January Hatch <br />Quarter 2 - April <br />h,acCcc ] - July --> Sc1�Ccmhr.r <br />Qliarter 1. - October --> 1%ecember <br />I <br />end to: <br />IICT 40 10/86 <br />SAN .JOAQIJIN LOCAL HLAI_•I'll DIST'RIC1' <br />1601 F. fiazelton , p.0 . Box 2009 <br />Stockton, CA 95201 466-6781 <br />