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9 4-1 • <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Names S S Cowan <br />FacilitY;Address: 639 W. CEay S . <br />Stioclz�an La. <br />Telephone: 209-9484302 <br />Person Filing <br />Report Baud aaP�c <br />FV I <br />I hereby certify under penalty of perjury that all inventory variations for <br />the above eeationed facility were within the allowable li.r+tr coy `ins- <br />Quarter. (110 i^ r -1v .0 �` Che Inventory Reconciliation Sheet) <br />Inventory variations exceeded the allowable limits for this quarter. 1 <br />hereby certify under penalty of perjury that the source for the variation <br />Ifss not due to an unauthorised (leak) release. (lies is Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank 1, and amount for all variations that exceeded the <br />Allowable limits. <br />Date Tank I Amount <br />2. <br />---------- <br />4. <br />S. <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 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 submitted within iS days of the end of each <br />Quarter. <br />Quarter 1 - January --� Harch <br />Quarter 2 - April Jurle <br />Quarter ) - July --> September <br />Quarter 4 - October --> (>ccember <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Haze l t o►il , 1' . 0 . Itc�x I()()9 <br />�r0 10/86Scockton, CA 05101 466-G7bl <br />T <br />