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r to <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORK <br /> facLUty N+wt—\�.�., <br /> mlalG�slc���r.� Task Sign lcoduet <br /> ' Pa\.rp_ obi 0 <br /> facility Mlnaa� _a �qc <br /> Telephone/ <br /> Person Filing <br /> Report _ o <br /> I hereby certify under penalty of perjury that alt inventory variation• for <br /> the above mentioned facility were within the allovable limits for this <br /> quarter. (No is Column 13 of the leveatocy Reconciliation Sheet) <br /> Iaventocy variations exceeded the allowable limits for this quarter. I <br /> hereby acetify under penalty of perjury that the source foe the variation <br /> was DOC due to am unauthorised (leak) reLeiee. (Yes in Column 13 of the <br /> laveatocy Reconciliation Sheet) t t <br /> List dates task /r and amount <br /> allowable limits. for all variations that exceeded the <br /> Date Tack I Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amountx shall be cootioued on a separate sheet of <br /> Paper and aCcached. <br /> if the source of the —riation which cNceeded alluw ble limits was due to <br /> • leak the incident shall be reported to SJ . L . H . D . Environmental 1(ealth <br /> . <br /> within 24 hours and an unauthor, ted release report submitted. <br /> Q arquarterly sumarcrr. y report shall be submitted within IS days of the end of each <br /> Qua CCCf I - January --) M.Irch <br /> Q•aarter 2 - April <br /> ar er ) - July --> 5ep(cm6.!r <br /> Quarter 4 - October --> Dec.•mher <br /> Send CO: SAN JOAQUIN LOCAI. 11tA1.1'li DISTRICT <br /> 1601 L . Ilnr.t• 114111 , 11 .0 . Rox 2007 <br /> l0/H6 Stockton . (;A 75201 466-67h1 <br />