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EHTORY RECONCILIATION <br /> Oct i <br /> QUARTERLY SUMMARY REPORT FORM 1589 <br /> Facility Name: Tank i SizBERMi / nuc <br /> Facility Address: if oz <br /> 5V qcgd 5- 03 <br /> Telephone : <br /> Person Filint <br /> Report <br /> E] 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 /> y <br /> rO 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 cc an unauthorized (leak) releise_ (Yes in Colum 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tack 1, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank I Amount <br /> 1. <br /> 2- <br /> 3. <br /> 4. <br /> Additional daces/amouets shall be contieued on a separate sheet of <br /> paper and attached. <br /> If the source of chc variation which. exceeded allowable limits was due co <br /> a leak the incident shall be reported to S ,J ,L.H . D . Environmental Hcalch <br /> within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summ,cy report shall be submitted within 15 days of the end of each <br /> Quarter. <br /> Qu .ccer I — January --> March <br /> Q•iarccr 2 - April --> JunC - <br /> <,Quactcr 3 July --> ScpCcmM r� <br /> - ---> <br /> Quarter 4 - --October December <br /> Scnd cc: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160L E. Haze 1 t 4+n . 11 .0 . Box 2007 <br /> SIockCOn , CA 75201 466-67bl <br /> LILT 40 10/ 86 <br />