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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT TORR �P� NG'VS <br /> Facility Na,• ri Tank / <br /> Size Product <br /> Facility Address: <br /> Telephone : <br /> Person F li n <br /> Reporc(: j�l1 <br /> ❑ I hereby certify under penalty of perjury that all inventory variatioaa for <br /> the above mentioned facility were within ehe allowable limits for this <br /> quarter. (Ho is Colu® 13'f the loveacory Reconciliation Sheet) <br /> Inventory variation• exceeded the allowable limits for this Quarter. I <br /> w+• not due <br /> hereby certify uodee penalty of perjury that the source for the variation <br /> to ao <br /> unauthorized (leak) release. (Yes in Column 17 of the )(!1✓!! � : <br /> Iaveatory Reconciliation Sheet) U <br /> List date, tank 1, sad aa.ouac for all variation• chat exceeded the v <br /> ■;lovable limics. <br /> Date - Lank ! Amount <br /> AddiCioaal dates/za uats shall be continued on a a <br /> se rs s <br /> Paper and attached. separate sheet of <br /> Lf the soucce of the variation which exceeded allowable Limits was due co <br /> a leak the incident shall be reported to <br /> within 24h0urs and an unauthorized rc Lcasc report wbmietedo Environmental Ilcalth <br /> The cly <br /> Quar(cr. summary report shall be submitted within 15 days of the end of c.ich <br /> (uurt.•r I - January __) Merth <br /> Q.arccr 2 - April --) J.,,,,• <br /> �.a rccr ) _ . <br /> July __) icptcmbcr <br /> Q`•a rt er 4 - October --) Ovccmber I <br /> Send co: SAN JOAQUIN LOCAL HEALTH UI !i'I'I( IC'1' i <br /> i <br /> 1401 1' . Naze Iliu1 • 1' . 0 Box ';1109 <br /> 40 l0/Nb Stockton . CA 95201 444 -41bi <br /> 1• <br />