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AENTORY RECONCILIATION S 51999 <br /> r <br /> QUARTERLY SUMMARY REPORT FORM rl p°rNinTi"sER 4C oTA <br /> ti <br /> Iaciiity Namat Eb -;W.. x.44 a,i Tank I <br /> Product <br /> Paeilit llddresat ' r <br /> . r� <br /> Telephone : 9y6 - <br /> Person Filing <br /> Report <br /> e • hereby certify under penalty of perjury that all inventory <br /> the above mentioned facility were within the allowable limits forthis <br /> for <br /> quarter. (No in Column 13of the lmvemtocy Reconciliation Sheet) <br /> 0 I=-fta"ry variations exceeded the allowable limits for this quarter. I <br /> bereby certify under penalty of perjury that the source for the variation <br /> was DOC due to as unauthorised (leak) releiss. (you in Columm 13 of the <br /> Iavemtory Reconciliation Sheet) <br /> Last date@ cook 09 and amount for all variations that exceeded the <br /> allowable lismits. <br /> Date Tank i Amount <br /> 1. <br /> 2. <br /> ]. <br /> 4. <br /> 5. <br /> Additional date*/amounts shall be continued oo a separate sheet of <br /> Paper and attached. <br /> if the oaurce of the variation whichexceeded allowable Limits was due to <br /> • Leak the incident shall be reported to S .J .L.H . D. Environmental Health <br /> within 24 hours mad an unauthorised release report submitted. <br /> The quarterly susaaary report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - Jaauary --> March <br /> Quarter 2 - April --) June <br /> ( July --) September <br /> atter - October .-> December f <br /> Send to: SAN JOAQUIN LOCAL HEALTH UISTKICT <br /> 1601 E . 11azeltoai , P .O . ifOX 2009 <br /> CT 40 10/ 86 Stockton , CA 95201 466-67bi <br />