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• <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />FaciLity Name: D S S Company <br />� y <br />Pacility Address: 639 W. Cf -ay St. <br />ac an,1 72. <br />y'52-06— <br />Telephone: 948-0302 <br />Person Filing <br />Report Boyd Gnavu <br />• <br />10-28-87 <br />I hereby certify under penalty of perjury that all inventory variations Eo <br />the above mentioned facility were within the allowable limits for this c <br />Quarter. (Ko in Column 13 of the Inventory Reconciliation Sheet) <br />❑ Inventory variations exceeded the allowable: limits for this quarter. Z <br />hereby certify under penalty of perjury that the source for the variation <br />was not due to an unauthorized (leak) release. (lies in Columa 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank 1, and amount for all variations that exceeded the <br />allowable licnits. <br />Date Tank f Amount <br />2. <br />3. <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 Fubmitted within <br />quarter. <br />15 days of the end <br />_ 1 _ <br />QuarC.anuary <br />J--) <br />March <br />of each <br />carter 2�- <br />April --> <br />June <br />- <br />Quarter <br />July --> <br />Septemh(:r <br />OCT 2 9 1987 <br />4 - <br />October --> <br />(k--cember <br />Send to: <br />1' 110 10/86 <br />SAN JOAQUIN LOCAL HEAL1'li DISTRICT <br />1601 E. Iiaze 1 t c►n , P . 0 . lic�x 1OOc) <br />Stockton, CA 95201 466-6781 <br />ENVIROMENTAL HEALTH <br />PERMIT/SERVICES <br />