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0 <br />INYENT01tY ItECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name; <br />Jamar service <br />Facility Address; 4075 r. east❑ <br />Telephone: 462-8707 <br />Person Filing G <br />Report <br />0 <br />�I hereby certify under penalty of perjury that all'inventory variations for <br />the above mentioned facility were within the allowable liwits for this <br />quarter. (Ho in column D of the Inventory Recunciliation 51leet) <br />El Inventory variatious 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 (olusu�ll of the <br />luvegtory Reconciliation Sheet) <br />List date, tank f, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tauk / Amount <br />I• <br />2. <br />]. <br />4. <br />5. <br />Additional dates/amounts shall be continued on a separate sheet of <br />Paper and attached. <br />If the aource'of the variation which•exceeded allowable RuVmconWntal a to <br />a <br />leak tile incident shall be reported to S.J.L.11.A. <br />altil <br />Within 24 hours and an unauthorized release report submitted. <br />i1ie quarterly summary report shall be submitted within 15 flays of the end of each <br />quarter. <br />Quarter I - January --> March <br />Quarter 2 - April --> June <br />Quarter I - July -;) September <br />er October --> Deccm5e <br />Send to: SAN JOAQUIN LOCAL HEALTH <br />Box 2009 <br />DISTRICT <br />1601 E. llazelton, P.0 <br />Stockton, CA 95201 <br />UCT 40 10/86 <br />466-6781 <br />