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7 <br /> INVENTORY RECONCILIATION APR 13 1089 <br /> QUARTERLY SUMMARY REPORT FORM <br /> CN11Ii20NMr;NTAI HEALTH <br /> PERMIT!SERVICES <br /> Facility Name: T Tank E Size I Product <br /> 140 o 00 oza <br /> Facility Address: SCO E (buoy 1A a oo h <br /> Telephone : 00S� 461-1301 <br /> Person Filing <br /> Report •So"'t 4u-w- <br /> E] 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 /> Inventory variations exceeded the allowable Limits for this quarter. t <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, tack i, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 2. 3 i g.c T 2.oS <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amount: shall be continued on a separzte 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.H . D . Environmental Health <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 each <br /> quarter. <br /> YQuartcr 1 - January --) Marchl4'i <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> sepcember <br /> Quarter 4 - October --> fk:cvmber <br /> Send co: SAN JOAQU IN 1,0CA1. HEALTH DIS'1'1t iC1' <br /> 1601 h; , Haze 1 t (111 . 1' . 0 . 1iox ')009 <br /> SLockcon . CA 95201 466 -67b1 <br /> 11l;T 40 10/ 86 <br />