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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM ppR 1 ? 5989 <br /> F II <br /> Facility Nana:{}}'pt)ti1u f TTank ank ik prod <br /> uct <br /> Facility Address: �4�S�L? �t� t �lYA aE 12D Telephone :PersonF�.lingReport �, a )p Q 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 I3 of the Inventory Reconciliation Sheet) <br /> Inventory variations exceeded the allovable '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 i0 and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 2. f- 11 �& <br /> 3. -gam �)4. <br /> , <br /> r <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 unauthorised release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of each <br /> quacter. <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 . liox 2009 <br /> Stockton , CA 95201 466-6781 <br /> UGT 40 10/86 <br /> nbi�m <br /> a <br />