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INVENTORY RECONCILIATION PQM 6 \ <br />QUARTERLY SUMMARYY REPORT FORM <br />ractuty Name: ,% 11',, <br />FACE lit Address: P <br />4div, (30 4, <br />Telephone: _ <br />Person Filing <br />Report <br />E] 1 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 columa I]of the inventory Reconciliation sheet) <br />ElInventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />vas not due to an unauthorized (leak) releise. (Yes in Colusm IJ of the <br />Inventory ReconciliationSheet) <br />List date, tank /, and amount for all variations that exceeded the <br />allowable limits- <br />Additional dates/amouota shall b._ continued oo 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.II.O. Environmental Ilcatth <br />within 24 hours and an unauthorised release report submitted. <br />The Quarterly aum<aary report ■hat( be submitted within 15 days of the end of each <br />quarter <br />Quarter I Januar --) March <br />- <br />Q'raT' cr - Aprit --> J. <br />ar er - u y --> icptcmhcr <br />Quarter 4 - October --) Deccmber <br />Send to: SAN .JOAQUIN 1.0CA1. HEALTH UIS'INICT <br />1601 R. IiazellI'll , P.O. R„x 2(1(17 <br />Stockton. CA 95201 466-61b1 <br />UGI. 40 10/86 <br />Date <br />Tank f Amount <br />2.rl-y <br />Z O <br />3- <br />4. <br />S. <br />Additional dates/amouota shall b._ continued oo 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.II.O. Environmental Ilcatth <br />within 24 hours and an unauthorised release report submitted. <br />The Quarterly aum<aary report ■hat( be submitted within 15 days of the end of each <br />quarter <br />Quarter I Januar --) March <br />- <br />Q'raT' cr - Aprit --> J. <br />ar er - u y --> icptcmhcr <br />Quarter 4 - October --) Deccmber <br />Send to: SAN .JOAQUIN 1.0CA1. HEALTH UIS'INICT <br />1601 R. IiazellI'll , P.O. R„x 2(1(17 <br />Stockton. CA 95201 466-61b1 <br />UGI. 40 10/86 <br />