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INVENTORY RECONCILIATION JUL <br /> QUARTERLY SUMMARY REPORT FORM � $ <br /> Facility li t H r Efti b�IRONMENTAL HEALT H <br /> . r �: C'z,. -�900. rank I <br /> Size Product <br /> Fxcility;Address; r� t <br /> Telephone : <br /> Person Filing <br /> Reporc <br /> l' <br /> I hereby 1651 LE?itl .J y cerCify under PenzItY of <br /> the above mentioned facility were with nYthe,alLovablecntorLim forati <br /> for <br /> quarter. (Ne is Oolu� 13 of the Inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable limits for this quarter, 1 <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 !, and amount for all variations that exceeded the <br /> allowable limiCa_ <br /> Date Tank I Amount . <br /> I. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> AddiCiooal dates/amounts shall be continued on a separate ■hect of <br /> Paper and attached. <br /> If the source of the variation vhich. exceeded allowable limits was due to <br /> a leak the incident shall. be reported to J . L. H , D . Enviro <br /> within 24 hours and an unauthorized release report submitted. Health <br /> The quarterly summary report shall be nubmicced vithin 15 days of h <br /> gUartcr_ the end of ea ch <br /> Quarter - January --) March <br /> *iarecr Z _ <br /> —�— April --� June <br /> Qwarccr 3 - July <br /> '-> ScryCc+nhe:r <br /> Qu artcr 4 - October --) <br /> D4--crmbcr <br /> Send co: SAN JOAQUIN LOCAL HEALTH 'UIS-J'ItIC'I' <br /> 160L E . HaZQ 1 L(m , <br /> 4U LO/86SLockr-on , CA 95'201 466 -6781 <br /> � <br />