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INVENTORY RECONCILIATION APR 151982 <br /> QUARTERLY SUMMARY REPORT FORM ENV{ROME'TAL HEALTH <br /> F ER3�hIT/ <br /> FaciLfity H2=c: �. c c lTank i <br /> V Size. Product <br /> Faci,.lity Address: <br /> .. <br /> Telephone <br /> Person Filing . ... - <br /> Report ' <br /> Z,2 <br /> ED` 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 13 of the Inventory Reconciliation 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 /> vas 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 /> Date Tank I Aaouut . <br /> 1. <br /> 2, <br /> 4. <br /> S. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. excceded al'lowablc limits was due to <br /> a leak the incident shall. be reported to S S .J . L.H . D .J . L.H . D . <br /> within 24 hours and an unauthorized release report submictedQ ntal lfcal[h <br /> The quarterly summary resort shall be Aubmi,tted wl' <br /> quarter. thin IS days of the end of each <br /> artcr11 - January --> Hirch <br /> Q'aarter 2 - April --> Junc <br /> Quarter 3 - July --> sepcemhcr <br /> Quarter 4 - Octobcr --> f3ccember <br /> Send to: SAN JOAQUIN LOCAL HEAL11i UIS'1'1QC-1- <br /> 160L H . H.-1701LOil . P . O . Box 2009 <br /> -Stockton. CA 95201 " <br /> 466 -6781 <br /> �" <br /> 1-0 10/86 <br />