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.10-5-89 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Hame: S S mm�an�i <br />Tank f Size* Product <br />Facili•ty;Address:639 W. Clay St. G1 10 000 Gal unleaded <br />D1• ID 000 Gal diesel <br />OC on, a. •D2 ' 6 000 Gal diesel <br />Telephone: 948-0302 wasteoil 1,000 Gal em t -remove <br />Person Filing <br />Report Boyd Groves end�n <br />s <br />I hereby certify under penalty of perjury that all inventory variations for <br />the above wentioned facility were within the allowable limits for this <br />quarter. (—Ko in Column 13 of the Inventory Reconciliation Sheet) <br />Inventory variations exceeded the allovable limits for this quarter. <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to an unauthorized (leak) release. (Yes ict Columon..13 Pf. the .. <br />Inventory Reconciliation Sheet) <br />List date, tank f, and amunt <br />allowable limits. for all variations that exceeded the <br />Date Tank F Amount <br />1. — <br />Z. <br />3. <br />4. <br />Additional dates/amounts shall b,* contig on selaarate 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 Rubmitted 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 --) 0-ccember <br />Send to: SAN JOAQUIN LOCAL. HEALTH DISTRICT <br />1601 E. Haze I t on , P.D. lacy 'l.009 <br />Stockton, CA 95201 466-67b1 <br />�' "0 10/66 <br />