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-INVENTORY RECONCILIATION <br /> SLY SUMMARY REPORT FO , <br /> Facility Name: 2_1V #1 1 Tank-J. Prod <br /> t <br /> Facility Address: <br /> Telephone: <br /> Person Filing <br /> Report: <br /> Q I hereby certify under Penalty, of <br /> perjury <br /> variations for the above mentioned facility hl <br /> tywerewithinnthey <br /> allowable limits for this quarter. ( ro in coli 13 of the <br /> Inventory Reconciliation Sheet, ) <br /> QInventory variations exceeded the allowable limits for this IL <br /> quarter. I hereby certify under penalty of perjury that the <br /> source for the variation was not due to authorized (leak) <br /> release. (Yes in column 13 of the Inventory Reconciliation <br /> Sheet) <br /> List date, tank , amount for all variations and the reason <br /> for exceeding the allowable limits. <br /> Date Tank Amou..nt Reason <br /> 4 : <br /> 5. <br /> Additional dates/amounts shall be. continued on a separate <br /> sheet of •paper and attached. <br /> If the source of the variation which exceeded allowable limits <br /> was due to a leak, the incident shall be reported to Public <br /> Health Services of San Joaquin County_ Environmental Health <br /> . Division, within -twenty-four ('24) hours and an unauthorized <br /> release report submitted. <br /> The quarterly summary report shall be submitted within fifteen (15) days of <br /> the end of each quarter. Circle appropriate quarter. <br /> Quarter 1 -- January---------->March <br /> Quarter 2 - April ----------->June <br /> Quarter 3 - July -------------->September <br /> Quarter 4 - October --------->December e <br /> Js.'_�' d to: <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E. Hazelton Ave:, P.o. Box 2009 <br /> Stockton, CA 95201 <br /> EH 23 019 (10/89) (209) 468-3420 ` <br />