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QUARTERLY SUMMARY IZFPOR 1 FORM <br /> Facility flame: IAIY1tY1VCtdZ.V TQWAQt 17r,/C. "Cznic' I �- - Size Product � <br /> -icilit, kddress: <br /> Person Filing ` _- <br /> Report G� W-A&S(;(2k <br /> E( 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 Column 13 of the Inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) release. (Yes in Column I3 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank t, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank t Amount fir _ <br /> OCT 2 1987 <br /> 4. CNVIROMENTAL HEALTH <br /> 5. F EWAIT/SERVICtS <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.H. D. Environmental Health <br /> Within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter 1 - January --? ?larch <br /> Quarter 2 - April --> June <br /> quarter j77)- 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 466-6781 ` <br /> UGT 40 10/86 <br />