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INVENTORr RECO,NCILIArlOn <br /> OuARiEalr SUMMARY REPORT FORM ENVIRONMENTAL�HEALTH <br /> raciLicp NaaK; ,T c• TOlyrlr n PERMIT/SERVICES <br /> reeille Tank I Site <br /> 7 Address: Product <br /> �9Yn0 O 00 ct <br /> Telephone : ° °p °O Q <br /> ese <br /> Person FLLLng Al 0 G Y <br /> Report • 0a p •e £ <br /> S /el/P /Ammavq Q0L) eL <br /> 1 hereby certify <br /> the above under penalty of perjury that allinventoc <br /> zeatin Co facility were within the allowable liaita for <br /> Quarter. Y vaciatiooa for <br /> (No is Colum were <br /> the Inventory Rcconeiliation Sheet) <br /> Chia <br /> QInventory variations exceeded the allowable Linits for this hereby certify wader penalty of perjury that the source for the variation <br /> W48 Got du quarter. t <br /> e to •a uaauchocixed (leak) celeiae. (ren io <br /> Inventory Reconciliation Sheer) <br /> r r Column 13 of the <br /> List dates Caok <br /> •llowab Is and mount for all exceeded variations that e <br /> le li.ita. the <br /> 1 <br /> I- <br /> Date <br /> Tank / Amount 1 <br /> Additional dates/+mouots shall be continued on a separate sheet of <br /> paper and ac(ached. <br /> If Che source of the variation ufrich exceeded allocable lin ns vas d <br /> + leak the <br /> ane rent that! b I <br /> Within a reported to ue [o <br /> Z4 hour• and an unau Uwr ' S •.1 . 1 rt suD. ictej.Environmental IlCal [h <br /> reed Tetrose report sub.itted. <br /> qurlrcrr. Ply aua.a•rry report •hail be a4.bmitcc4 wichin 15 days of the end of each <br /> (r.ar (Cr 1 - Jaou ar <br /> Q'urtcr Y --) H-11ch <br /> April ._) Ja1n• <br /> tr.arcCr I - J•.ly --> <br /> Q•u rt a•r G 1a•PtCmher <br /> October --) (4-cembcr <br /> 'c^d Co; <br /> SAN JOAQUIN LOCAL 11EAL-1•1i DISTRICT <br /> 1401 f; • I:art• Ilrnl , P .O . Ilnx %1101) <br /> 1 IA�Sb tituckton • CA 95201 4(,4 67b1 f <br />