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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM CMOT0 t6tt O�tV 1CtkVe LL <br /> Facility Name: ����t��s, C ',� ;��� ��� �� ����,� l�+��, Tank # Size J Product <br /> o <br /> Facility Address : ►`i> <br /> Telephone: '944 - 'i <br /> Person Filing <br /> Report: , C S L e > <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 /> a 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 . - )(0-`o -t- I ) �. Gca`��►�S <br /> 2 . 1 - 30- 90 -,- 139 <br /> 3 . Co - % - qo <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----------- <br /> Quarter 2 - April------------>June _ <br /> Quarter 3 - July------------->Septemberj� �,� <br /> Quarter 4 - October---------->December it <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT LIAR 2 0 1991- <br /> 1601 E. Hazelton, P.O. Box 2009 EN'y' ONMENTALHEALTH <br /> Stockton, CA 95201 468-3420 PERMIT/SERVICES <br /> LII 23 019 10/86 <br />