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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: �VYlIfS ��(}(f `�Dr I n Tank ! Size Product <br /> � C'('C ICCc <br /> Facility Address: E. �(� RSI Z- IC GC( At <br /> av5 <br /> Telephone : <br /> Person FLli <br /> R <br /> Re ort ort �kA�A��j�'�',+,c <br /> f' 7 l�l.0(1(CtLx f <br /> 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 Colu® 13of the Inventory Reconciliation Sheet) <br /> 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 as uaauthoriced (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheer.) <br /> List date, teak f, and samount for all variations that exceeded the <br /> allowable limits- <br /> Date Tank / Amount <br /> 1. SAW <br /> Z. � <br /> 3. OCT 7 1988 <br /> 4. ENViRONMENTr'.L HEALTH <br /> 5• PERMIT I SERVICES <br /> Additional dates/amouaCs chill be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which exceeded allowable limits vas duc to <br /> . Luk the incident shall be reported to S .J . L . H . D . Enviconmental licalth <br /> within 24 hours and an unauchortr.cd release report submitCed. <br /> The Quarterly suom ry report shall be aubmiL(ed uichin 15 days of the end of each <br /> QuaCtcr <br /> QVarcer I - Janu.ry --) H.irch <br /> QQiartcr 2 - April --> June <br /> Quarter ) - July --) septcmhcr <br /> Quarter 4 - octobcr <br /> Send co: SAN JOAQUIN I.00AI. HEALTH UIS"I'NICT <br /> 1601 1: . Hazc I I iul . V . 0 . Hox 1009 <br /> Stockton . CA 95101 466- 67bl <br /> aa' <br /> 1-0 10/86 <br />