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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Namer_oL -7-&�-1 '.< (� C�NlE' �cE - Tank i Size Product <br /> Facility Address: <br /> Telephone : ],�� - <br /> Person Filing <br /> Report <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 /> 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 1, and amount for 211 variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. erceeded 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 I - January --> March <br /> Qu a r t e r 2 - April --> June <br /> urter J - Jul <br /> �arer 4 - October jkencembe0 � a3� 111:�LJ(/41I+1]�� 411 1`Y►/ f ~IV'�I <br /> JA Nd 6 1989 <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENPiERMIT/ERVICESITH <br /> 1601 E . Lore l I oil , 1 0 . Box '2009 <br /> Stockton , CA 95201 466-6781 <br /> U(;T 60 10/ 86 <br />