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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: r 7-2 <br /> r' Tank <br /> YZ int _. Size Product <br /> Facility Address: Ov'rI c <br /> Telephone : <br /> Person Filing <br /> Report LAW LJ O5 a1.) <br /> 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. (Ho in coluam 13 of the inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allowable limits for this quarter. X <br /> hereby certify under penalty of perjury that the source for the varixtioa <br /> was not due to an unauthorized (leak) release. (lyes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank i, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank P Amount . <br /> 1. <br /> z. <br /> 4. <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 al-lovable Limits vas du` to <br /> r Icak Elie incident shall. be reported to S .JH p Environmental l3calth <br /> WLthin 24 hours and an unauthorized release report submitted. <br /> rhe quarterly s....,ry report shall be Fubmitted vithin 15 days of the end of each <br /> quarter. <br /> Quarter I -- January Harch <br /> Q•.1arter 2 - April --> June <br /> Quarter a - July --} Septcmh(:r L <br /> parte 4 - Octobcr -> December ;"N '' � <br /> k` <br /> Scnd to: ✓ <br /> SAN JOAQUIN LOCAL HEALTH DI5'1MC'1' <br /> 160 L I; . I: `r.c 9 t(<li , I' , 0 . ESnx I()(}g L'NVIRONIENTAL HEALTH <br /> /to 10/ 86 iLockton , CA 95201 466 -67b1 FERfA1T/SERV1 ES <br />