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r <br /> o <br /> INVENTORY RECONC � IAT;I,ON �H <br /> QUARTERLY SUMMARY REPORT FOR�ip,\. \'�-v'y S <br /> SERV\OE <br /> Facility Name: BILL MORROWS SFiELLEN ank # Size §ProdLuct <br /> GO r a <br /> Facility Address: ° 1071 No. Main �5jj Wt" Oil <br /> 000u <br /> Telephone : <br /> Person Filing <br /> 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 /> IVq 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 to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank #, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank # AYaunt <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded allowablelimits <br /> was due <br /> ueeto <br /> a leak the incident shall be reported to S .J .L .H . D . <br /> alth <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. <br /> Quarter I - January --> March <br /> Qiarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTKIC'1 <br /> 1601 E . llazelton , P .O . BOX 2009 <br /> Stockton , CA 95201 466-6781 <br /> U(;"1' 40 10/ 86 <br />