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! 'TT <br /> OUAllrrI <br /> T �}. p <br /> OYENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Nam: E6 k'ocl,q ) Rfl�S po?7; e J Tank Size Product <br /> 17 oov D <br /> 3aeilitr;Addreut _2 S)3 400 .., ;S Ate. o00 <br /> %t J <br /> CA . 4S1oS 'DO WgSp ;L <br /> Telephone : 9y ¢ 1 60i.9' S 7occ AS <br /> Person Filing <br /> Report <br /> 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 13of the Inventory Reconciliation Sheet) <br /> Inventory 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 13 of the <br /> Inventory Reconciliation Sheet) APR, 1989 <br /> List date, tank /, and amount for all variations that exceeded the <br /> allowable limits. Z ,iifiieitJi cS <br /> Date Tank It Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheen of <br /> paper and attached. <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 acid 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 I - January =-) march,) <br /> - Apr Cl——) June <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --) December <br /> Send co: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . IlazelLon , P .O . Rns 2009 <br /> Stockton , CA 95201 466 -678L <br /> 'CT 40 10/ 86 <br />