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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> /YI MdRKrr MWFacility Name:Facility Addre3as 4hlh {GnrnNv I�f.At�mrt> CA 95 2Lv <br /> Telephone: fLi'3) y33 -`i3� c <br /> Person FYlinq—'t)e N 1`e <br /> Report: <br /> 0 I hereby certify ander penalty of perjury that all inventory vadadoog r 0 3 V E D <br /> the above aaattomed facility were within the allowable Limits for this <br /> quarter. (No in Column Ilof the loveatory Ileconeili&tLon Sheet) 0 C T 12 1910 <br /> a. J <br /> ENVIRONMENTAL HEALTH <br /> Iaveotopr variatibes exceeded the allowable liana for thla quarter.' IU RMIT/SERVICES <br /> hereby certify under pantry of perjury that the source foe chs war tett <br /> was not dw to am unauthorized (leak) releise. (Yea Lo Colum I7 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and aaouat for ail variations that exceeded the <br /> allowable linics. mount <br /> Date Tank # ✓'`-- <br /> 2:i—_: 11 - ---- - I r9 <br /> 3. IV-Ci � - <br /> 4. !7- , 1 C1 <br /> 6. <br /> 7. Cd ZI tt3 ,a t —iz54 <br /> B. <br /> —41- <br /> 9. i,--1 t1 '� - 4-1 <br /> 10. Y-`i -A "3 5k <br /> 11. <br /> 12. uLI) C' —ISO <br /> 13. 4-._7 u 1 { A-au <br /> 14. 12_- I , 1215 <br /> 15. tiff-'LV {a I t 2'7u -� <br /> 16. Lh ''3 u 1 1145 <br /> 17. 7-F'S I L cv '� -14-5 <br /> 18. i 4- 17 - u54- <br /> 19.--7a <br /> 1 54-19. N} 25 <br /> 20. 1,42 L3 <br /> 21. 2 .' - �11— 4. t I 5 <br /> 22. <br /> 23. <br /> 24. <br /> 25. <br /> 26. <br /> 27. <br /> 28. <br /> 29. <br /> 30. <br /> Additional dates/sexwats &hall be continued on a sepsrate sheet of <br /> paper and attached. <br /> If the source of the variation which.exceeded at't"abletlimits <br /> mwas <br /> due <br /> to <br /> a task the incident shall be reportcJ to S.J.L.H.D. <br /> atch <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly sumary report ■halt be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --> March <br /> Quarter 2 - April --> June <br /> Quarter I - July --> September <br /> Quarter 4 - October --) Dcccmber <br /> Seed to; SAN JOAQUIN LOCAL HEALTH D1S't'MLCT <br /> 1601 E. Ilazeltsm. P.O. 11ox 2009 <br /> . Stockton. CA 95201 466-6781 <br /> ;T 40 10/86 <br />