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APR 0 6 1992 <br /> INVENTORY RECONCILIATION LNVIRONMENTAL HEA1 TH <br /> QUARTERLY SUMMARY REPORT FORM PERPOIT/SERVICL.S <br /> Facility Hmme: Z97_ �1'ruel,_I;A16 �Qc_ Tank # Size Product <br /> Pecility,Address: <br /> Telephone : 4 0 9';1-62L)1) <br /> Person Filing <br /> Report <br /> hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in, Column l3 of 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 /> van not due to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheec) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. <br /> Z. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which- exceeded at-lovable limits was due to <br /> 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 summary report shall be rubmirrcd within 15 days of the end of each <br /> quarter_ <br /> QuarterI - January March <br /> Quarter 2 - April June <br /> Quarter 3 - July September <br /> Q­rCcr 4 - October 0,ecemt)er <br /> Send Co: SAN JOAQUIN LOCAL 11EA1,TH DISTRICT <br /> 160 L E . Haze I t (m . 1) . 0 . hox 2( 09 <br /> S L o ck L on . ("A '15201 466 -6781 <br /> L MT !+0 10/ 86 <br />