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3 l� <br /> / L <br /> INVENTORY RECONCILIATION APR 41989 <br /> QUARTERLY SUMMARY REPORT FORM [,dVlRONMIENTAl. NEA�TH <br /> - ��ar���r 1 FSERV ES <br /> Facility. Hame: A - <br /> ��►�►0 .- - Tank I Sire. <br /> F�cilit Product <br /> Y llddreas: V d d <br /> Telephone <br /> Person Filing <br /> Report h.bH�x�r' c <br /> 14y�,Lj <br /> ----------- <br /> aI hereby certify under PenaltY of perjury that 1the above -entioned facilitywere <br /> hl <br /> / "Q <br /> ions for <br /> quarterits <br /> mnColumn 13of the lnventoryReconciliation Sheet) <br /> ElInventory 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 unauthorised (leak) release. {Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) - et <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank I Amount .. <br /> 1. <br /> 4. <br /> 5. <br /> Additional datcats shall be continued on a separate sheet of <br /> Paper and attached. <br /> Ii <br /> the source of the variation which. e xcto <br /> within <br /> allowable limits was due: <br /> a leak the incident shall, be reported to S .J . L.1i , D . Environmental llcal[h <br /> ithin 24 hours and an unauthoritcd release report submitted. <br /> The quarterly 5umcaarY report shall be nubmi <br /> quarter. CCed within IS days of the end of each <br /> Q�+arCcr I - January March <br /> Quarter 2 _ April -_> June <br /> Quarter ) - July --) Septcmh(!r <br /> Quarter 4 - OcCober - ? r)cccmbcr <br /> Send to' SAN JOAQUlt4 LOCAL HEALTH DIS-1-RICT <br /> 1601 <br /> 10/HG 5Lockton , CA 95201 4GG-6781 <br />