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INVENTORY RECONCILIATEOh JUL <br /> QUARTERLY SUMMARY REPORT FORM <br /> FacilityName: ONI <br /> ',"nnm c•�:�:�. "Q' <br /> SHAUGHNESSY CAR WASH Tank f Size Product <br /> Facility Address: 601 F. Miner Avenue 1 6 000 Rea!!],ar <br /> 12 000 Sumer Uni, <br /> Stockton CA 95202 3 12 000 Rea, ural <br /> Telephone : ( 209 ) 465-2542 <br /> Person Filing <br /> Deport Lila Billheimer <br /> X hereby certify under Penaltyf <br /> of that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in Column13of 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 /> vas not due to an unauthorized (leak) releise. (Yes in Column 0 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> L. <br /> 2. <br /> 3_ <br /> 4. <br /> 5. <br /> Additional dates/amou©ts shall be continued on a separate sheet of <br /> paper and attached. <br /> If 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 submicced. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quarter_ <br /> QuYrCer I - January <br /> Q'iarter 2 - April <br /> Quarter 3 - July -Q scptemhcr <br /> Q�arCcr 4 - October --) 1}CC(.Mt)er <br /> Send to: SAN JOAQUIN LOCAL HEALTh DISTRICT <br /> Swckwn , CA 95201 466 -6781 <br /> �T 40 lel/fit} <br />