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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Jackpot Ma <br /> Facility,Address: 401 S r <br /> .. :., iernteP Tine <br /> _ Lod;_ CA-9594o. <br /> Telephone : <br /> P _ (209) 46,9-56,5 <br /> Person Filing <br /> Report Joe Sanzo <br /> ❑ I 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. (Ho in Column 13 of the Inventory Reconciliation Sheet) <br /> aInventory 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 so unauthorized (leak) release. k_yX)gA;LX9ff*NM%1Xgf-K1*1XPFX1414��XA'XACSR14kR%AXAxXI4X$SJiil� (Based on daily measurement error only.) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amouac <br /> 1. SEE ATTACHED INVENTORY CONRTOL SHEET <br /> Z' ASTFRTSKS DFNOTF VART4T1MlS FX('FFT1T <br /> NG ALLOWABLE LI?fITS. <br /> 3. <br /> 4. <br /> 5. <br /> AddiCional dates/amounts shall be continued on a separate sheet of <br /> Paper and attached. <br /> If the source of the variation whichexceeded allowable limits was due Co <br /> a leak the incident shall be reported to S .J . L.H . D. Environmental llcalch <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be Aubmitted within 15 days of [hc end of each <br /> qu.rccr. <br /> Quarccr I - January --) March <br /> Quarter 2 - April --> Ju.c <br /> Quarter ) - July --> sepcemher <br /> Q.arccr 4 - October --) G? ccmber <br /> co' SAN JOAQUIN LOCAL HEALTH UIS'1'ft1C'1' <br /> 160L E. llazelLon , P . O . [tOx 2()09 <br /> UCT 40 10/86 Stockton , CA 95201 466 -6781 <br />