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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: E. F. Kludt & Sons, Inc. Tank f Size Product <br /> 1 20 00 1UnI Plus <br /> Facility Address: 1126 E. Pine Street 2 0 00 R <br /> Lodi, Uailfornia 95240 30 D <br /> Telephone : (209) 368-Q63l, or 466-8969 <br /> Person F ng ` <br /> Report ��\&;: <br /> 7 <br /> 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 13of the Inventory Reconciliation Sheet) <br /> 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 an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. „I <br /> ��,7'�� <br /> Date Tank I Amount IV�I �:. 3W..J 1111 <br /> , <br /> 2. 198 7 <br /> 3. ENVIRONENTAL HEALTH <br /> 4. F ERN11T/SERVICES <br /> S. <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.11 . D . Eovironmental neai:ii <br /> within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the end of cacti <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 /> Stockton , CA 95201 466-6781 <br /> UGT 40 10/86 <br />