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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name : <br /> Tank / Si -?;1�;:11�•' . <br /> zef Product <br /> Facility Addre . • : <br /> Te lephone : �j� U? a013) <br /> Person <br /> Report� r. yiJ LZ FjiUrll � <br /> L hereby certify under Pcaalcy of perjury that all inventocy variations for <br /> the above mentioned fac " ' Cy were within the allowable li . ita fir Chia <br /> quarter ' ( No in Column IJof the Lnvencory Reconciliation Sheet ) <br /> Invcncory variation . exceeded the allowable Limits for this quaccec . I p <br /> hereby certify under penalty of perjury that the source for the vnri . tion 1/ <br /> '48 not due Co as unauthorized ( leek ) release . ( Yes in Colin p of the 1/ <br /> Inventory Reconciliation Shcec ) <br /> List date , tank / , and amount for ALL variations that exceeded the <br /> y allovabie limits . <br /> JII <br /> Date Tank / Amount ^� <br /> 4 . I L Q yfJ <br /> L O� <br /> Additional daces / amounts chall be continued on a cepa tate . hceC of I <br /> paper and attached . <br /> I <br /> Lf <br /> the <br /> source of chc variation which exceeded allowable limits was due Co <br /> a leak the incident shall be reported to S _ J . L . H . D . Environmental Ilea lth <br /> " Chin 24 hours and an unauthorized release rcPorC submiCted .- <br /> The quarterly summary rePore shall be submittcd within 15 days of the end of cacti <br /> quarter . <br /> (hurtrr I - Jaau . ry <br /> Q, acI r 2 - April <br /> Quarter I - it, Iy <br /> Quarter 6 - October - - ) December <br /> Send co ; SAN JOAQU IN LOCAI . HEALTH <br /> 1601 E . I : azvll , ui , 1 ' . 0 . Row 1009 <br /> f0 / N6 Stockton . CA 95201 460 - Glbl <br /> 2, U <br />