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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />acLUty. N PUBLIC WORKS <br />FAcility4d4ress 1810 E. HAZELTON <br />•,.. - TS CKTON, ' CA 95205 <br />Telephone: 209 468-3074 r <br />Person Filing, <br />Report JUNE OKUBO <br />I hereby certify wader penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />quarter. (No to Column 13of the Inventory Reconciliatioct et) <br />aveatory variations exceeded the allowable limits for thisquarter.' I <br />hereby certify under penalty of perjury that the source foe the variation <br />was not due to an unauthorized (leak) releiise. (Yes is Col 13 of the <br />Euveatory ReconciliationSheet) <br />�i <br />-List date, tack t, and &Aouat for all variations Chat exceeded the <br />all able Limits. <br />Date Tack 0 Amount , <br />-,IQ-23-90 1 103JA N <br />2• 10-26-90 2 133 ENVII 199 <br />3. 10-10-90 3 121 R ITI R L HEACividti K <br />4. 11-1-90 2 268 <br />S. •12-26-90 2 280 <br />ditiooal dates/ammoucts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which. exceeded al'lowabte limits was due to <br />a leak the incident shall be reported to S.J.L.N.D. Environmental, health <br />Within 24 hours and an unauthorized release report submitted. <br />The quarterly suanary report shall be submitted within 15 days of the end of each <br />quarter. <br />Quarter l - January --1 March <br />Quarter 2 - April --' June <br />Quarter l - July --) septemhcr <br />Quarter 4 October --> t)ccembcr <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazelton. P.O. Rox 2009 <br />Stockton, CA 95201 466-6761 <br />EH 23 019 10/86 <br />0 <br />V . <br />