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r I • V�1a��F� .l3pp�-tea, <br /> IerEl(roer a(COC ILIArion APR i 4 !S92 • <br /> QUARrERl1 SUMMARY REPOR r FORM " 1"JALHEALTH <br /> M+.+t <br /> �-r . . 'ot:hwriocQ I. <br /> ♦ssllicy <br /> �. rank / Stce <br /> hsLlItp Addrpst Id4Cs�7 Product <br /> Telsphona; : <br /> Person FLLLe - ` 4 <br /> Report — <br /> L 1141rsb2' certify undsc - <br /> Cbs •boys Neseiesed facility <br /> of Pcriury chat ail inventor va <br /> SWaeter. (� is GoIWNe 13 "ere Within the ■llowab y ciatioos for <br /> e( the <br /> lsvcaCoc l lc lisic• for Chia <br /> y aconciliatioe Sheet) <br /> 0 Lsveecory vari•ciosa eaceedN t 4 <br /> hereby csccif he allowable Lisita for this <br /> W40 Got due o •adac pcoalty of Perjury that the •Darts for Vuacter. t <br /> to •• usauchorsacd (leak) reLeaas. Che war' <br /> Lsveatocy Aeconciliacion Sh Of is Co Lu 113 of theins <br /> cec) <br /> / <br /> Lt•c date. task /a ••d •Nemec foc all variacio•• chat cccccli the <br /> allowable liwits. <br /> 1 <br /> Dat: rank / AMOU <br /> 1. <br /> Z. <br /> 4. -----� <br /> Paios•1 dot <br /> Paper <br /> 41114 at <br /> ctachc4"QWoca shall be eonciauad e• • aCp.r.cc she <br /> ec of <br /> :f Zcie source a( the variation ..hicA exceeded alluwbl <br /> a leak the incaJCot shall be reported within to a li.its ..as due to <br /> 24 hours and an Wnaachor ' S •J . L. II D, Enviro <br /> ,ted release report subsi ^Ncncal Ilea lth <br /> Ills 9Wartsrl cceJ. <br /> Q wrtnr, y sW�ry rr,pert <br /> *hall be subsittcd WicAin 1) days at the end of cacti <br /> W artPl 1 January •_) M... <br /> Q'aa, I..' rh <br /> Wartc, 1 J,a,u. <br /> July .->Wsa• .arta•r 4 October Iltobrr <br /> •_) I4'crehcr <br /> pend co: <br /> tial+ JOAQUIty UICAI. IICAI.'1'li DISTRICT <br /> Ibgl I I:ait ll ,ul , I' ,1), Uux 2Np'/ <br /> 1 10116 Stockton , CA 'J5201 466 .4Jb1 <br />