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0 0 <br />. INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name; <br />Jamar service <br />Facility Address: s ''a -g' Maill <br />Telephone: 462-8707 <br />Person Filing <br />Report G <br />I hereby cgrtify under penalty of perjury that al1. inventory Variations for <br />the above mentioned facility were wirhin the allowable limit$ for this <br />quarter. (No in Column "Of the Inventory Reconciliation Sheet) <br />E] Inventory vartatious exceeded the allowable limit$ 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'Coluam 17 of the <br />lavegtory Reconciliation Sheet) <br />List date# tank /, and amount for all variations that exceeded the <br />allowable lislits. <br />Date Tank f Amount <br />2. <br />3. <br />4. <br />5. _----- <br />Additional dates/amounts shall be continued ou a separete sheet of <br />paper and attached. <br />If the $ource'of the variation which. exceeded allowable limits was due to <br />a leak the incident 011.111 be reported to S.J.L.II.U. Ruvironmental Health <br />within 24 hours and an unauthorized release report submitted. <br />The quarterly summary report shall be submitted within 15 day$ of the end of each <br />quarter. <br />Quarter 1 - January --> March <br />quarter 2 - April --> June <br />Quarter 7 - July -,-i September <br />Quarte zTu er -- Uecem er <br />Send to; SAN JOAQUIN LOCAL HEALTH 'DIS'1RICT <br />1601 L. Ilazelton, P.O. Box 2009 <br />Stockton, CA 95201 466-6781 <br />UGT 40 10/86 <br />