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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: Yank I Product <br /> Facility-4ddreaa: <br /> 77 <br /> Telephone :�0�� 9s <br /> Person Filing <br /> Report //;r_• �/� �e�✓� <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. (Ho in Column 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 unauthorized (leak) ret"ae. (Yes in Col, 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 1. <br /> r _ <br /> 2. <br /> 3- <br /> 4. <br /> 5. <br /> Additional date,/amaants shall be continued oo a separate sheet of <br /> paper and attached. <br /> If the source of the variation vhich. ex.ecded 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. PuzoQuarter 1 - January --> June �P,�IQinrter 2 - April --> Junc [lV' (/� <br /> Quarter ) _ Jowly —> sepccm 19� JAPd 6 1989 <br /> Quarter 4 October --) Dec<mber <br /> �_ _ NVIRON� <br /> S<nd to: SAN JOAQUIN LOCAL HEALTH DISTRICT PERMjf% IVICyITH <br /> 1601 E. Hazelton , P .O . Box 2007 <br /> Stockton , CA 95201 466-6761 <br /> JGT 40 LO/86 <br />