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INVENTORY RECONCILIATION OCT 18 <br /> QUARTERLY SUMMARY REPORT DORM r-NMR0NN13P�TALHEM,IF1 <br /> PERMIT 1 SERVICES <br /> Facility Name: L /liJ - , rank # Size Product <br /> Z uU <br /> Facility Address: !J G u <br /> Telephone : l'8 7 0 <br /> Person Filing <br /> Report I - t; _ �s� <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 /> vas not due to an unauthorized (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank #, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> gaper 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 /> Quarter I - January --> !larch <br /> Quarter 2 - April --> June <br /> Quarter - July --> September <br /> gar ec Ti - 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 /> UCT 40 10/86 <br />