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l \\ <br /> viA 19 '7 <br /> 01� 1 <br /> INVENTORY RECONCILIATfON <br /> QUARTERLY SUMMARY REPORT FORM Cmont�a,r� Ctl ektAcLkVe IL <br /> Facility Name: 2' C)�,J � , � Sc�iod" 1 ,Tank # Size Product <br /> Facility Address : i`3 hf• �� '� ,�� G`�� �� OC>C) s k <br /> Telephone: 9q4- CSC <br /> Person Filing <br /> Report: , CkAA -0. 5 <br /> I hereby certify under penalty of perjury that all inventory variations <br /> Q 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 due 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 . � - �� - � ►a,c>M � � �� fi � � � G�IIa� � <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 1 - January---------=>March <br /> Quarter 2 - April------------>June <br /> Quarter 3 - July------------->September � I�I <br /> Quarter 4 - October---------->DecemberL` <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT 11AR 2 0 1991' <br /> 1601 1% Hazelton, P.O. Box 2009 ENVIRONMENTAL HEALTH <br /> Stockton, CA 95201 468-3420 PERMIT/SERVICES <br /> L11 23 019 10/86 <br />