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ORECENt... ... <br /> INVENTORY RECONCILIATION JUL 3 1991 <br /> QUARTERLY SUMMARY REPORT FORM ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> FAIcility Name: g �/ Tank I Site Product <br /> Facility Address: /U l,ur 7 Y 4 -' ?C� �• <br /> Telephone : <br /> Person Filing <br /> Report „/ f - .✓ <br /> 19 L 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. (oto 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 as unauthorized (leak) release. (Yes in column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, and amount for 211 variations that exceeded the <br /> allowable limits. <br /> Date Yank f Amount <br /> I. <br /> z. <br /> 3. <br /> 4. <br /> S_ <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 allowable limits was dui; 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 submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter_ <br /> Quarter I - January --) H.irch <br /> " Q�arCcr April --> June <br /> arCcr - July --) Septemhi!.r <br /> (h,artcr 4 - October --) fA�cvmber <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160 1 E . Haze l t o�n , 1' . U . 15Ox 2()00 <br /> St_ ockron , CA 95201 1466 - 67bl <br /> 11t;T 40 10/ 8() <br />