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Facility Name: D S S Company <br />Facllity;Address: 639 W. Clay St. <br />Stockton, ca- <br />Telephone: <br />a.Telephone: — 209_94R_n�n7 <br />Person Filing <br />Report Boyd Groves <br />i. <br />X� I hereby certify under penalty of perjury that all inYento Variation <br />the above aentioned facility were vi thin the allowable liwits for thsfor <br />quarter. (No is Column 13 of the Inventory Reconciliation Sheet) <br />hereby <br />eby <br />Inventory vaciaCioas <br />herexceeded the allovable limits for this quarter. I <br />certify under penalty of perjury that the source for the vatriatioa <br />..13 vf. <br />-49 not due to an uaauthorixed (leak) rele�ice. (Yes in Column <br />lnvcntory Reconciliation Sheet) the.._` <br />List date, tank 1, and amount for all variations that exceeded the <br />allovable lio,ita_ <br />Date Tank f Amount <br />1. <br />z. <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'lovable limits vas due to <br />A' leak tfie incident shall be reported to <br />Within 24 hours and an unauthorixed re least report ;'s�ubmictedonmental llcalth <br />The quartcriY summary report stiall be Kubmitted within 15 days of the end of cacti <br />quarter. <br />Quarter I - Januar > Harch <br />9-artcr 2 - April --> Junc <br />Quarter ) -y <br />Jul --> Scptcmhcr <br />Quarter 4 - October --> fkcember <br />send to: SAN JOAQUIN LOCAL'.HEALTH .UISTHICT <br />160 t E.. liazr 1 1 crit , t' .0 . 1lox V009 <br />Seockton, CA ()5"101 466-67b1 <br />�. 140 10/86 <br />,. <br />