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r 61 ,I' <br /> .� INVENTORY RECONCILIATION JUL 211989 <br /> QUARTERLY SUMMARY REPORT FORK111'?0NMENTAL HEAM) <br /> ERM!T/SERVK'F <br /> Facility Name: Pu ,� Tank # Size Product <br /> Facility Address : / 1 7— U <br /> _ Z 5 <br /> Telephone: c c <br /> Person Fili g T o <br /> Report: <br /> I hereby certify under penalty of perjury that .all inventory variatio, <br /> for the above <br /> ithin the allowale limis for <br /> this quarter. m(No lineColumn 113yofethe re wInventory ReconciliationtSheet <br /> ❑ Inventory variations exceeded the allowable limits for this quarter. <br /> hereby certify under penalty of perjury that the source for the varia. <br /> tion was not due to unauthorized ( leak) release. (Yes in Column 13 of <br /> the Inventory Reconciliation Sheet) . <br /> List date, tank # , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tank # Amount <br /> 1 . <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet <br /> paper and attached. <br /> If the source of the variation which exceeded allowable limits was <br /> due to a leak, the incident shall be reported to San Joaquin Local <br /> Health District; Environmental Health Division, wit-hill twenty-four <br /> (24 ) hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15) days <br /> of the end of each quartQr. <br /> 'Quarter 1 January---------->March <br /> er 2 - April------------>June <br /> Quarter 3 - July------------->September <br /> Quarter 4 - October---------->December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton, P.O. Box 2009 <br /> Stockton, CA 95201 468-3420 <br /> Ell 23 019 10/86 <br />