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� INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM JUL or �98� <br />�. Facility Name C=�ii�r��.� �<;7;.�'<� L��afE-�l.�I ' - Tank / ,,q m - duct <br /> Z4 644- ZAr <br /> Facility Address: ,�7c)p/ R' �/„y fr, <br /> ZZirl,2 c7—" � , — <br /> Telephone : ac 9 -,¢' T 3 -26,P/ <br /> Person Filing <br /> Report LJJ,tJC Tr;'Gec �. <br /> X <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. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> E] 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. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts 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 . Environmental llealch <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 /> af a R ry --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July -- September <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Hazel ioil , P . 0 . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> LR;T 40 10/ 86 <br />