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INVENTORY RECONCILIATION ti V <br /> QUARTERLY SUMMARY REPORT FORM MAR 13 11989 <br /> L; <br /> Facility Name: sege .'S ft)Pm 0) 1 ry 1 �RKT Tank 1 7 product <br /> Facility Address: $S L-OU E 00C G� v�t� <br /> �• � 'L� Ell <br /> ATH cP, C A . q5 3 3c S LL gp <br /> Telephone : - F5S8- 0Z(o K 7 <br /> Person F'li'ng <br /> Report o�Cl-dfil <br /> I hereby certify under penalty of perjury that all inventory variations for <br /> 7� 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 an unauthorized (leak) release. (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 /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which exceeded allowable limits was due to <br /> a leak the incident shall be reported to S .J.L.H.D. Environmental Health <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 I - January March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December 11�9 <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . Hazelton , P .O . Box 2009 <br /> Stockton , CA 95201 466-6781 <br /> IICT 40 10/86 <br />