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RECERD <br /> &INVENTORY RECONCILIATION 16 JAN 8 10So <br /> QUARTERLY SUMMARY REPORT FORM ENVIRONMENTAL HEALTH <br /> Facility Name : AHFPIe_AA1 .SAVII� �41�fl< Tank PERMIT/SERVICES <br /> IIT/SE VICESct <br /> 1 <br /> Facility Address : 1588 UCKya eCoveT' 1LJWkWFb <br /> N <br /> 0 IV CA <br /> Telephone : /0 - &I-0q <br /> Person Piling <br /> Report :, V'I LAK4 AIVTUNIU <br /> I hereby certify under penalty of perjury that all inventory variation: <br /> for the above mentioned facility were within the allowable limits for <br /> this quarter . ( No in Column 13 of the inventory Reconciliation Sheet , <br /> Inventory variations exceeded the allowable limits for this quarter . <br /> hereby certify under penalty of perjury that the source for the varia- <br /> t'ien was not due to unauthorized ( leak ) release . (Yes in. Column 13 of <br /> the Inventory ReconeiliaCion sheet ) . <br /> List date, tank # , and amount for all variations that exceeded <br /> the allowable limits . <br /> Date Tank # Amount <br /> I . LU-05- 89 L1. 8 <br /> 2 . 10 -zZ-89 2. 10 . 4 <br /> 3 . 20 -27- 89 1 1S. v <br /> 4 . 11 0 - 89 1z. .y <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, within 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 quarter , <br /> Quarter 1 - January---------->March <br /> Quarter 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, D.O. box 2009 <br /> Stockton, CA 95201 466-3420 <br /> EH 23 019 10/86 <br />