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ahA lctcio <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM Nc7�t6­,m,J Cdi�ev(�cc�1ve <br /> Facility Name: `��< ,. �,,�'. ;' 1 �G�noo\ D;` ,'Tank 4 Size Product <br /> IC C'CC` <br /> Facility Address : 193). K� ' E; F�ncA Dr , <br /> »oc_�-_fio' Ca . <br /> Telephone: <br /> Person Filing <br /> Report: , L`.\ �. .- <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 . 4QC:r- <br /> 2 . 4 -4- f � <br /> 3 . 49 - 9U <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 <br /> ;e all' <br /> Quarter 4 - October---------->December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT MAR 2 0 1991 <br /> 1601 E. Hazelton, P.O. Box 2009 <br /> EN <br /> Stockton, CA 95201 468-3420 P� HEALTH <br /> PERMIT/SERVICES <br /> LII 23 019 10/86 <br />