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%001 Nod <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name: <br />Facility Address: <br />Telephone: 209 3 <br />Person Filing <br />Report: JIM <br />QUARTER'ENDING 6-30-92 <br />APRIL, MAY, JUNE <br />Product <br />I hereby certify under penalty of perjury that all inventory variations <br />F-1 <br />for the above mentioned facility were within the allowable limits for <br />this quarter. (No in Column 13 of 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 varia- <br />tion was not clue to unauthorized (leak) release. (Yes in Column 13 of <br />the Inventory Reconciliation Sheet). <br />List date, tank #, and amount for all variations that exceeded <br />the allowable limits. <br />Date Tank # Amount <br />1. <br />2. <br />3. <br />4. <br />5. <br />Additional dates/amounts shall be continued on a separate sheet <br />paper and attached. <br />If the source of the variation which exceeded allowable limits was <br />due to a leak, the incident shall be reported to San Joaquin Local <br />Health District; Environmental Health Division, within twenty-four <br />(24) hours and an unauthorized release report submitted. <br />The quarterly summary report shall be submitted within fifteen (15) days <br />of the end of each quarter. <br />Quarter <br />1 <br />- January ---------- >March <br />Quarter <br />2 <br />- April ------------ >June <br />Quarter <br />3 <br />- JulY------------- >September <br />;� +F 4e,,., <br />Quarter <br />4 <br />- October ---------- >December <br />Send to: SAN <br />JOAQUIN LOCAL HEALTH DISTRICT <br />J U L 0 2 1992 <br />LHEALIH <br />1601 <br />E. Hazelton, P.O. sox 2009 <br />PERMIT/SERVICES <br />Stockton, CA 95201 468-3420 <br />EIII 23 019 10/86 <br />