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� fLi <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> L1.1'IR0" HLA!TH <br /> racWtjr Nit Tank / <br /> Site Pro uc <br /> 1[acLLEty Addeesa: <br /> Telephone: -- 4 1 <br /> Person Filing <br /> Report <br /> L heceby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> Quartee. (No is Colum 13 of the inventory Reconciliation Sheet) <br /> ❑ Inveatocy variations exceeded the allowable Limits for this Quarter. I <br /> heeeby certify under penalty of perjury that the source for the variation <br /> was not due to an uaauthorized (leak) release. (Yes in Column 13 of the <br /> Lnveatory Recoaciliation Sheet) I , ( <br /> 1 <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable Limits_ <br /> Dace Tank 11 Amounc <br /> i. <br /> 2. <br /> J. • <br /> G. <br /> S_ <br /> Additional daces/amouncs shall be concioucd on a scparace sheet: of <br /> paper ind accachcd• <br /> if Chc aou cc O( (hC vAC t.2t ion vhtCh r turd a1 lO-a t)I c • l t m t C% -as dut- CO <br /> leak Chc tnctden( shall be rch,r( co t ., ) ( ({ O Envtronmen(al Ilealch <br /> wichi� ZL hours and an unau(ho. tr<d r. Ic.)sr rct•or( submtCCca1 <br /> t�tc Quar(eCly -""nary C4t)0CC shall br A..bmt ((ed vt(htn 0 days of Chc end of rack <br /> 9 u.r ( r r . <br /> QuaCCCC I - January <br /> Quaeeer ] - July <br /> Qa.arCcC 4 - occobcr --) 11i�ceanhcr <br /> Scnd co: SAN JOAQU I N 1.()l:Al. HEA1.11i U 1 %TK I CT <br /> 1601 1: . H.ir • I I tin . V .0 Ro x K009 <br /> Stockton , CA 95201 466 -67bl <br /> 40 10/H6 <br /> �Iu CJs. 1 "�rl{ `i+i Y(:.fV:i K11C•.e" iso.n�.m�.rd M .t5a1'i'i '::G w :..*.:5: '_'.w1.^",N.tA9"; ."_k'fV'.- . .._•.. ..-1 -...ee. _.e . ... . -- - .......�—....... .........4..�.....- <br />