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INVENTORY RECONCIL [Ar [ OR <br /> QUARTERLY SUMMARY <br /> REPORT EORti <br /> • Facility Name: ` /�L✓tii l,�iY'� <br /> a� Tank I Site <br /> Facility Address: �,�pIle, I Product i <br /> Telephone : <br /> Person Filing <br /> Report ���c�� ® <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 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 An unauthorized (leak) release. (Yes in COW= 13 of the <br /> Iaventory Reconciliation Sheet) <br /> List date, tank t, and amount for all variations that JPJallowable limits. Y Int <br /> 1. �2 Date Tank I Amount MAR 171989 U <br /> /�a <br /> Z <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <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. exceeded allowable limits vas due to <br /> a leak the incident shall be reported to S .J . L.H. D. Environmental Health <br /> within Z4 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be Fubmitted within <br /> quarter. IS days of the end of each <br /> Quarter 1 - January --> March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July -J September <br /> Quarter 4 - October --) 1lecember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> • 160L F.' . Haze l t Tui . P . O . Itox 2()09 <br /> 40 10/8G <br /> Stockton , CA 95201 466-6761 <br />;1' - <br />