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4 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> FxciLity Name: g <br /> Task I size Product <br /> Fmcil ty Address: r" A/ <br /> l V <br /> Telephone : �2a el, C�Gp <br /> Person Filing <br /> Report <br /> I hereby certify under penalty ofer'uryainventory <br /> the above mentioned facility were within theallowableli�mitsvfor this <br /> variations far <br /> quarter. (No in Column 13 of the Inventory Reconciliation skeet) <br /> ElInventory 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 ao unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> Allowable limits_ <br /> Date Tank f Amount <br /> z. M"" E C E I E <br /> 3. J U L 0 6 199`0 <br /> 4. ENV'IRQNIVIENTAL HEALTh <br /> s_ <br /> PERMIT/SERV111 ES <br /> Additional dates/:mounts shall be continued on a separate sheet of <br /> paper and attached_ <br /> If the source of the variation which exceeded al-lowable limits was due to <br /> A leek the incident shall be reported to S . J . L D . Environmental Ilea Ich <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 --) Harch <br /> (darter 2 - April --> June <br /> Quarter 3 - July --) Septemh(-r <br /> Q�larter 4 - October --) Ikcember <br /> send to_ SAN JOAQU IN 1,0CAL HEALTH DISTRICT <br /> T <br /> 1601 F. . E.arc� E < <�ia , l' , (7 . fi()x 1OOg <br /> 40 10/ 86iI- ockLon , CA X15101 466 -67151 <br /> I'li(;T <br />