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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORH <br /> • Facility Name T MlJ�4L .�)Ac r- Tank I <br /> Site Product <br /> Facility Address: Ia0 &j �9 <br /> .3iy c�Cia LIA <br /> Telephone : 1016$ -a�63 <br /> Person Filing j <br /> Re p o r t _ 46AJ C�=YL �G91a <br /> FL 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 tbi■ 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 Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank t, and amount for all variations that exceeded the <br /> allowable limits. <br /> . Date Tank I Amouat <br /> I_ <br /> I. <br /> 3. <br /> 4. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> Paper and attached_ <br /> Lf 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_ :i <br /> arter .I <br /> � - January --) March {" DECc� <br /> - April --> June w W Lj 490 <br /> 1 <br /> arter 3 <br /> - July --) ScpCemher <br /> Quarter OCCObcr --) Oeccmber <br /> �_..,.; <br /> Send to: PER�IIi i E.. <br /> SAN JOAQUIN LOCAL HEALTH UIS'I'R [C1' <br /> • 160L E , I!azc 1 t nn , p .o . liox 'LOOS <br /> SIOCkCOn , CA 95201 466-6781 - <br /> ;T 40 10/86 <br />