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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />FaILkity,Name: L STAR INDUSTRIES,, INC. <br />P:eiliry Wdress: 30350 S. Tracy Blvd. <br />Telephone: <br />-835-1454 <br />Person FiliR"g- <br />e pRICH BIER <br />M MW <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 />Inventory 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 Col 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank f, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank # Amount <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 al'lowabLe 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 />Send to: <br />UCT GO 10/86 <br />Quarter I - January --> March <br />i�'rb'" <br />carter - April --> June � <br />i <br />Quarter 3 - July --> September <br />Quarter 4 - October --> DecemberP <br />SAN JOAQUIN LOCAL HEALTH DISTRICT ENVIti CYi aNI 8 iL HEALTH 1 <br />1601 E. Ilaze 1 t een . P.O. BOX 2009R1%41T/SER\110ES <br />Stockton, CA 95201 4.66-6761 <br />0 <br />7 <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 />Inventory 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 Col 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank f, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank # Amount <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 al'lowabLe 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 />Send to: <br />UCT GO 10/86 <br />Quarter I - January --> March <br />i�'rb'" <br />carter - April --> June � <br />i <br />Quarter 3 - July --> September <br />Quarter 4 - October --> DecemberP <br />SAN JOAQUIN LOCAL HEALTH DISTRICT ENVIti CYi aNI 8 iL HEALTH 1 <br />1601 E. Ilaze 1 t een . P.O. BOX 2009R1%41T/SER\110ES <br />Stockton, CA 95201 4.66-6761 <br />0 <br />7 <br />