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_ REGEIRU <br /> INVENTORY RECONCILIATION MAY 2 0 1989 <br /> QUARTERLY SUMMARY REPORT FORMEWPON MENTAL HEALTH <br /> FER1IiT/SERVICES <br /> Facility Name: Jacknot Sank f <br /> Size Product <br /> Fxcilkt Address: n <br /> y�_ .. . _ 4(71 4 rfi rrnkPP r ::11 G x111 . <br /> d Prem U L <br /> Telephone : r,no} zFo-s� lO 000 U L Re ula <br /> Person Filing <br /> Report Joe Sanzo <br /> E] I hereby certify under penalty of perjury that all inventory variations for <br /> Che above mentioned facility were within the allowable limits for this <br /> quarter. (No in Column 13of the Laveacory 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 an unauthorized (leak) release_ (X1l74X7CAX '4� <br /> (�k ��XJTXF9G7t)P7C7CX71X ZC.T?Z??XAAR}t1t7) (Based on daily measurement error�onnlly. ) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. SEE ATTACHED IWEATORY CONRTOi SHIFT <br /> Z' ASTFR T4KS DFN(7TF V4RT�TTnNC F\'r r.rnrr <br /> J. <br /> `G ALLOWABLE LIMITS. <br /> 4. <br /> S. <br /> Additional dates/amouacs shall be continued on a separate sheet of <br /> Paper and attached. <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 /> Within 24 hours and an unauthorized release report sub iccedonmental Ncalth <br /> The quarterly summary report <br /> Quarter. shall be aubmittcd within 15 days of the end of each <br /> Quarter 1 - January --> March <br /> QQiare(tr 2 - April --) June <br /> Quarter ) - July --> Scptcmhr.r <br /> Quarter 4 - October --) 1)ecember <br /> Send to: SAN JOAQUI(+ LOCAL. HEALTH UIS'1'ii [CI' <br /> 1601 E . HQZCllnn , P .O . ttoX 2p0q <br /> UCT 40 I0/86 Stockton , CA 95201 466 -6761 <br />