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INVENTORY RECONCILIATION <br />7-12-89. QUARTERLY SUMMARY'REPORT FORM <br />rae i Li tr t(ame s D S S Company <br />._-__ Tank f S i z e <br />Product <br />Pacili•ty;Addre■.: 639 W. CL's S G1 10 000 -Gat uvteaded <br />D1-Nuoc '1 0 0 -Ga <br />Telephone: 209-948-0302 dieae� <br />ave, a. G D2'• `6 000 GatcLi.es e2 <br />Jaisteoit 1 000 Gat Em it at Tris <br />Person Filing <br />Report Boyd Gnoves time. (jilt b <br />Taken out a <br />,� Gnouvcd �saon. <br />© I hereby certify under penalty of perjury that all inventory variations <br />the above .reationed for <br />facility were within the allowable licit■ for this <br />quarter• (t(o in cOiun= 13 of the Inventory Reconciliation Sheet) <br />ElInventory variations exceeded the,allovable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />wa■ not due to an unauthorized (leak) release, (Yes in column.13 vf. the.... <br />Inventory Reconciliation Sheet) <br />List date, tank f, and amount Eor all variations that exceeded the <br />allowable limits. <br />Date Tank E Amount <br />1. <br />z. <br />4. <br />5. <br />Additional dates/amouats shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which.exceeded at•lowable limits was due to <br />At 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 sumrnjry report shall be Fubmitted vithih 15 days of the end of each <br />quarter. <br />Quarter I - January :-) karclt <br />Quarter 2 - April <br />Quarter 3 - July --> September <br />Quarter 4 - October --> [h'ccmber <br />Send to: SAN JOAQUIN LOCAL HEALTH .DISTRICT <br />1601 E. .)laze 1 t ()n , P .0. Box <br />Stockton, CA 95201 466-67b1 <br />