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4-16-91 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />racility N <br />Facile <br />39 W. Clay <br />Stockton Ca. 95206_' <br />Telephone: 948-0302 <br />Person Filing <br />Report — Boyd Groves <br />X <br />"PRECEIVEi <br />APR 2 2 4nol 9,* <br />NVIRONMENTAL HEALTH <br />. PERM I T/SE RVICES, <br />I hereby certify under penalty of perjury that All inventory variations for - <br />the above -cnCioned facility vert within the allowable limitg for thi -5 <br />quarter, (—K0 in r-olu.. :3,f 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 tile variation <br />was not due to An unauthorized (leak) A <br />Inventory Reconciliation Sheet) rele"Ne' (Y" in COLUOMA3 9f. the <br />List date, tank 1, <br />allowable litnita. d amount foe,alL variations that exceeded the <br />Date Tank I Amount <br />1. <br />................ <br />x. <br />4. <br />5. <br />Additional dats/a-ouats shall be continued on a separate Sheet of <br />P2Pcr and ZtCachcd. <br />It the Source of the variation which.exceeded at'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 shalt be submitted vithih 15 days of the end o* <br />quarter. <br />f each <br />Quarter I <br />- January <br />a r t c r 2 - April June <br />Q-Irccr I - July September <br />Quarter 4 - October --> Occcmbcr <br />send to: <br />SAN JOAQUIN LOCAL'-MEALTH D I S -1 -It I CT <br />1601 E. -.11a7c It (m.; 1). 0. Ilox 2009 <br />40 t0/86 Stockton, CA 915201 466-67bl <br />