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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> G �t�/ -A-Sc �v r <br /> Facility Names Q .� Tank � Size. Product <br /> Facitity,Address: <br /> F U n/l-la gDc v <br /> 61Z_ 7 <br /> Telephone : <br /> Person Filing <br /> Report s� J sL�t�i9 <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility were within the allowable limits for this <br /> quarter. (No in column 13 of the inventory Reconciliation Sheet) <br /> QInventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to ao unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank f Amount <br /> 2. E U <br /> 3. AUG 0 <br /> 4. r_NVIRONMEN?-AL HEALTH <br /> s. <br /> PERMIT/SERVICES <br /> Additioaal dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. exceeded at-lovable limits was due to <br /> a leak the incident shall be reported to S .J . L. H . D . Environmental licalth <br /> Within 24 hours and an unauthorized release report submitted. <br /> The Quarterly summary report shall be submitted within 15 days of the end of each <br /> Quarter_ <br /> Quarter 1 - January --> March <br /> QU-1te- eC 2 April <br /> Quarter 3 - July --> sepcemhi-r <br /> Quarter 4 - October --> lkcember <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 I: . Hazelton , 1' . 0 . liox 2000 <br /> SLockCOn , CA 05201 466 -6781 <br /> Uc,'1' Q0 10/ 86 <br />