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OCTL1 Ly <br /> C 1988 <br /> 6V P NIt�,Eh•I I+EAL7H <br /> INVENTORY RECONCILIATION PERMIT/SERVICES <br /> QUARTERLY SUMMARY REPORT FORM <br /> QUARTER ENDING 9-30-88 <br /> Facility Name: TER F.CT TRIi(K7 TNI' Tank i Size Product <br /> 21-980 DIESEL <br /> Facility Address: 9004 VICTOR ROAD 2 5,000 GASOLINE <br /> LODI. CA, 95240 3 1,000 WASTE OIL <br /> Telephone : 209 36R-9479 <br /> Person Filing <br /> Report JIM HAIRRELL <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 13 of the Inventory Reconciliation Sheet) <br /> E] 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. <br /> Date Tank It Amount <br /> 1. <br /> 2- <br /> 3- <br /> 4. <br /> _3_4. <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 vhich. cxceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J . L . H . D . Environmental Hcalch <br /> Within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted vithin IS days of the end of each <br /> quarter_ <br /> Quarter I - January --> March <br /> Q•aarter ? - April --> June <br /> Quarter 3 July --> September <br /> Quarter 4 - October --> December <br /> Scnd to: SAN JOAQUIN LOCAL HEALTH DISTHICT <br /> 160L E . Hazcll (111 , P . O . ISox 2D1O`7 <br /> Stockton , CA 95201 466 - 6781 <br /> UCT 40 10/86 <br />