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INVENTORY RECONCILIATIOK <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Namc: GEWEKE FORD ' <br /> 70vs- s. Tank I <br /> Facilit fE E -- Size Product <br /> . y .'Address:P , O . BOX 1210 GP.SOLINE 100 G <br /> LODI . CALIFORNIA 95241-121 550 GALS <br /> Telephone : 209-334-0987 <br /> Person Filing <br /> Report UUC1 .. <br /> GX I hereby certify under <br /> the above it ally of Perjury that all inyentory variations <br /> meacxoned facility were within the allowable for <br /> Quarter. (No in Co Limits <br /> lunm U of Che laveocory Reconciliation Sheet) <br /> for Chia <br /> ect) <br /> ❑ Iaventory variations exceeded the allowable limits for C4ia <br /> hereby certify under Penalty of per that the source for <br /> wits not du quarter. I <br /> e to +a unauthorized (leak) release. (yes is Column <br /> variation <br /> laveotory Reconciliation Sheet) IJ of the <br /> List dale, rank sad smaunt <br /> Allowable limits_. for all variations that exceeded the <br /> D_i_Cc Tank I <br /> Amount <br /> I- <br /> 2- <br /> 3. ---- -- <br /> 4.5. <br /> �— <br /> �_ <br /> Addilioaal dates/amouocs chall be continued oa a cepa Cate sheet o <br /> PaPer and attached_ f <br /> If the source of the variation vhich. cxcecded al-lovable limits vas <br /> A leak the ineidcnt :hall be ccporced co <br /> within due to <br /> Z4 hours sad an unauthorized S rCP0rC D . Enyirana>cntal licaIth <br /> release rc po c[ submiC[cd. <br /> qartlc quarterly aumaa ry rc Port :hall be aubmicccd vithi IS <br /> u <br /> y f he end of each <br /> Quarter I - Jaauary <br /> --) Na rch <br /> Q�a ctcr 2 _ <br /> April --) June - <br /> Quarccr J _ <br /> Quarccr 4 - July --) Se p[cmhrr <br /> October --> Ik comber <br /> Send Co: <br /> SAN JOAQUIN LOCAL HEAL7'll DIS•1-1( lc1' <br /> 1601 I: . I;azcltrui , P . O . Hns 7009 <br /> 60 10/N6 Stockton , CA 95201 466 -6761 <br /> ' <br />