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I� <br /> YENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM JUL 111ggg <br /> heilitF Na.a: �D �ocly� �P.gvsct,ca/ - - _. ._ <br /> Tank Stcn toduct <br /> racilier�Addresa: x;79>-3 ( dAnfD <br /> Telephone : <br /> Person Filing c <br /> Report _ .;r 7 t '/ <br /> Lrl 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 Colum 13 of the Inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable Limits for thin quarter. I <br /> hereby Certify under Penalty of perjury that the source for the variation <br /> was not due to am unauthorised (leak) reLeise. (yes is Column 13 of the <br /> Iaveotory Reconciliation Sheet) <br /> List date, teak /p and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> Additional dates/amounts shall be contioued.on a separate sheet of <br /> Paper and attached. <br /> Lf 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 Hcal[h <br /> within 24 hours and an unauthorised release report submitted. <br /> the quarterly summary report shall be submitted within IS days of the end of each <br /> quarter. <br /> Quacte Jaowary --) March <br /> arter 2 - April ==> Jun- <br /> Aqvrrter--Y = 7ut SePtcmhcr <br /> Quarter 4 - October w-) Occember <br /> Send to: SAN JOAQUIN LOCAL HEALTH UISTHICT <br /> 1601 E . Hazelloai , P .O . Ilex 2009 <br /> GT 40 10/86 SLockton , CA 95201 466-67b1 <br />