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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> FaciLity Names Eli KocJ, 9 /'on; a .\-,j Tank I I Sise Product <br /> Facility�Addresal S Loo ,. ay, nc :a <br /> r <br /> ,roc hTo,J, C�) . 9S1 oS L/' <br /> Telephone : <br /> Person Filing <br /> Report <br /> L 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 /> 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) <br /> List date. tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> 1. Date Tank I Amount ROW <br /> 2. <br /> 3. APR 2 7 1989 <br /> 4• ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet 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 Bea Ith <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 /> 44uarter I'�'j January --) March <br /> �Quartcr 2 - April --) June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --) December <br /> Send c.o: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160L E . 1;zelDnn , P . O . lion 2009 <br /> Stockton , CA 95201 466-6781 <br /> LILT 40 10/ 86 <br />