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`INVENTORY RECONCILIATION 64 if , <br /> '%� RLY SUMMARY REPORT FOrtl( <br /> �itry a • <br /> Facility Name: J r�iLL �� /y <br /> Tank af t <br /> Facility Address: <br /> Telephone: <br /> Person Filing <br /> Report: <br /> EDI hereby certify under penalty- of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (F_o in column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> {� Inventory variations exceeded the allowable limits for this <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 Amount Beason <br /> 2 . r ? L4 X L 7f <br /> 3 . <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 - Januar -> - <br /> January March .. <br /> Quarter 2 - April ----------->June <br /> Quarter 3 - July >Se tember <br /> a Quarter..4 - October --------->December «� ; <br /> n to: , SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1601 E. -Hazelton Ave:, P.O. Box 2009 _ <br /> Stockton, CA 95201 <br /> (209) 466-3420 <br /> ....� <br /> EH 23 019 ... Y : <br /> (10/89) , <br />