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INVENTORY RECONCILIATION 10-28-87 <br />TA <br />QUARTERLY SUMMARY REPORT F0 r,;= ti.� HEALTH <br />QP' ! I ISEWCES <br />Facility Name;V S S Company <br />a <br />Fac ili.tY;Add reait 639 W. C.eay St, <br />oc on, a.. <br />Telephone: 948- <br />Persoc Filing 0302 <br />Report Boyd Gnova <br />r, <br />I hereby certify under penalty of perjury that all inventory <br />ions <br />the above Mentioned facility were within the allowable limsysvarforatithin for <br />quTrter. (No in Colu® 13of the Inventory Recanci ;lt:, r, sheet, <br />❑ti <br />Inventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variation <br />wit rnot due to an unauthorized (leak) release. (Yes is Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank 11, and amount for all v <br />Allowable limits. aciatioas that exceeded the <br />Date Yank E Amount <br />1. <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 Ieak 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 IS days of the cnd of each <br />quarter. <br />Quarter 1 - January :-) March <br />is r 2 - April --> June <br />Quarter - July --) September 0 %. ✓.�� V(IJU <br />Quarter 4 - October --> Ikccmber <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E•:.. (laze I t (m , l' . 0. It ox 2009 <br />Stockton, CA 95201 466-6781 <br />•1' 40 10/86 <br />