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�. INVENTORY RECONCILIATTO, <br /> JH <br /> REPORT FOR <br /> Facility Name: QUARTERLY SUMMARY C- Z <br /> Facility / Tank f size <br /> Address: !� / R / oduct <br /> Telephone : <br /> Person Fi <br /> Reportft <br /> 1 I hereby certify under penalty of perjury <br /> the above mentthat all inventory variations for <br /> ioned facility were within the allowable limits for this <br /> quarter. (No to Column 13 of the Inventory Reconciliation Sheet) <br /> j 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 as unauthorized (leak) release. (Yes in Column 13 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 f Amount <br /> 1 . _ RECEIVED <br /> 2. OCT 1 8 1990 <br /> 3. <br /> ENVIRONMENTAL HEALTH <br /> 4• PERMIT/SERVICES <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 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 suommry report shall be submitted within 15 days of the end of each <br /> quarter. <br /> Quarter I - January --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> 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 />