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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: San Joaquin Lumber Co. Tank / SiZe\'V Ipyo ' t <br /> 1 1.000 <br /> Facility Address: 235 W. Scotts Ave. 2 5,000 sel <br /> oc , on, Ua. <br /> Telephone : 465-5651 <br /> Person Filing c <br /> Report n. Schneider <br /> Q1 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 I]of the Inventory Reconciliation Sheet) <br /> E] Inventory 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 unauthorized (leak) releise. (Yes in Col unm IJ of the <br /> Inventory Reconciliation Sheet) <br /> List date. tank E, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 2. <br /> J. <br /> 4. <br /> 5. <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 allowable limits was due to <br /> a leak the incident shall be reported to S .J . L.H . D . Environmental Health <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be submitted within 15 days of the end of each <br /> Quarter. <br /> Quarter I - January --) March <br /> Q,jartcr 2 - April --> June <br /> r 1 - July --> September <br /> Quarter, 4 ' October --) lkcember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E' . Hazellon , P .O . Rox 2009 <br /> Stockton , CA 95201 466-67bl <br /> Ur,T 40 10/ 86 <br />