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INVENTORY RECONCILIATION <br /> July 6,1990 <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: _ OARNFf_TV Q17RA Tank 1 Stze. Product <br /> w <br /> Fecility,Addresa: 1R 00 CQggAl, 1101,LQL4 RD 2 �'1000.GAL. DIESEL <br /> RACY CA 95378 01105 "` <br /> Telephone : 415 455 5918 <br /> Person Filing , <br /> Report NnRM FOSTER <br /> K 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. (No in Column 13 of the inventory Reconciliation Sheet) <br /> inventory variations exceeded the allowable li®its for this quarter. ' I <br /> hereby certify under penalty of perjury that the source for the variation <br /> via not due to an unauthorized (leak) release. (Yeo in Column 13 of the <br /> 1pventory Reconciliation Sheet) <br /> i <br /> List date. tack 9, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank P AmountREC <br /> GENE1 <br /> 1• Th rl nnY FvCaarlad l i mi T_c J U L U 9 jtln <br /> ENVIRONMENTAL HEALTH 1 <br /> 3. — PERMIT/SERVICES <br /> 4. _ <br /> S. <br /> Additional dates/amouets shall be continued on a separate sheet of <br /> paper and attached. <br /> It 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. Environmental Health <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 1 - January --) March <br /> Quarter 1 - April --> June <br /> Quarter ) - July --> ,Sc tember <br /> Quarter 4 - October --> December - i <br /> Send to: SAN JOAQUIN LOCAL HEALTH DIS'1'R1CT j <br /> 1601 E , HaZC 1 un1 . 1' ,0. Box 1009 <br /> Stockton . CA 95201 466-6761 1 <br /> T 40 10/86 <br />