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l <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY RF_PORT FORM <br /> Facility Name; Jackpot tank E <br /> WOOOU� <br /> FAcilit Address: G <br /> - y ,. 40'L C- Ali Prnkee T na ¢ 1 <br /> T.odi. Ca n5 )G0 - G1.Z <br /> Telephone : <br /> p r�n9� �tF4_sFsi <br /> Person Filing <br /> Report Joe Sanzo <br /> ❑ I hereby certify under penalty of perjury that all inventory variatio <br /> the above mentioned facility were within the allowable limits forns for <br /> this <br /> quarter. (Ho in Column, 13 of the Inventory Reconciliation Sheet) <br /> QInventory 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. iX7Sk <br /> }1RRl4RFR7CgXR�Y7C14�1:X:17C#x7ll4t•?XbAkltd3� (Based on daily measurement error fonlly. ) <br /> List date. tank /, and amount for all variations chat exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1• SEE ATTACHED INVENTORY CONRTOL SHFET <br /> z. .aSTFR �x� <br /> 7 DFNOT_ z AZ1 TrnUc_ svZF_,`G ALLOWABLE LIMITS. <br /> 3. <br /> 4. <br /> S. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> Paper and aCtached- <br /> If the source of the variation which. exceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J .L. H . D. <br /> Envir <br /> within 24 hours and an unauthorized release report submittedonmental 11ealth <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> Quarter_ <br /> Quarter 1 - January --) March <br /> Quarter 2 - April --) June <br /> Quarter J - July --) ScpCcmher <br /> QUArrer 4 - October --) <br /> Orccmbcr <br /> Send Co: SAN JOAQUI:+ LOCAL HEALTH UIS'1'H1C,1' <br /> 1601 E . 1:a7.C1L(41 , P . O . liox 2009 <br /> UCT 40 10/86 Stockton . CA 95201 466 -6781 <br />