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c <br />iglu S, �e <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />FaeiUty Names JOHN 1AY1.0R FERTILIZERS <br />Facility Address: P. 0. BOX 6098 <br />STOeffell, C!AtIF, 95186 <br />Telephone: �' ' " <br />Person FILLng <br />Report Ci <br />I ai.vIna i T bo vot <br />APR 10 ',"_'-0 <br />ENyRONMENTAI- HEALTI' <br />PERMIT/SERVICE;; <br />Yank / Stze Product <br />a©lalAl f P <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 Colu® IJ of the Inventory Reconciliation Sheet) <br />❑ Inventory variations exceeded the allowable Limits for this Quaeter. I <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to an unauthorized (leak) releise. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List dater tank /r and as■ount for all variations that exceeded the <br />allowable limits. <br />Date Tank Amount <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 11.0. Environmental Ilcalth <br />within 24 hours and an unauthorized release report submitted. <br />the qua-Cerly summary rrport shall be submitted within 15 days of the end of each <br />quar(rr_ <br />Quarter I - January --) March <br />QQJarccr 2 - April --> Junc <br />Quarter ) - July --> septcmhcr <br />Quarter 4 - October --) Occember <br />Send co: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazvil,un. P.O. It(ix )1009 <br />S(ock[on. CA 95201 466-61b1 <br />U(;T 40 10/bb <br />W <br />