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INVENTORY RECONCILIATION-�, MEWED <br /> QUARTERLY SUMMARY REPORT FORM , APR 17 1,991 <br /> / PrP AICNTAF4,' ; , <br /> ., <br /> Facility Name: � /S/ �� - , H � ' <br /> G Tank i Size Product <br /> C�C <br /> Facility Address: `O �� 6�n Cn C:c <br /> ;2C r/ 3 <br /> Telephone : ' ?C <br /> Person Filing <br /> Report <br /> LlG <br /> L hereby certify under penalty of eru / / Sr (r` <br /> the above mentioned facility were within the aallowable ll elimitsntoryvfor athiss for <br /> quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> X1�C.0 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 av 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 / <br /> Amount <br /> 1 . <br /> 2. <br /> 3. <br /> 4. <br /> 5. -- <br /> Additional dates/amounts shall be continued on a separate sheet <br /> Paper and attached. of <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 submitted. <br /> The quarterly su—ry report shall be submitted <br /> quarter. within IS days of the end of each <br /> Quarter I - January --) March <br /> 9"arter 2 - April --> June <br /> Quarter 3 - July <br /> --) September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Hazelton , P .O . Box 2009 <br /> UGT 40 10/86 Stockton , CA 95201 466-6781 <br />