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44 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility. Name: Tank Size <br /> Product <br /> Facility,'Address: 5o Aj. An <br /> Telephone : _ yg- <br /> Person F <br /> Report �fbh4j^, i-1. <br /> WI hereby certify under penalty of perjury that all inventoryvariations for <br /> the above mentioned facility were within the allowable lims for this <br /> quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <br />. i <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 /> was not due to an unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) _ <br /> List date, tank i, and amount for all variations that exceeded the <br /> Allowable limits. <br /> Date Tank f Amount <br /> 2. ` <br /> 3• J U L 0 7 1992 <br /> 4. ENVIRONMENTAL. HEALTH <br /> S. PERMIT/SERVICES <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 al=lowable 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 />..:j The quarter! summary y re port shall be submitted within IS days of the end of each <br /> "i quartet. <br /> Quarter 1 - January --) March <br /> Quarter 2 - April --> June <br /> Quarter ) - July --> Septemhc:r <br />' Quarter 4 - October --> tkcember <br /> Send to: SAN JOA <br /> QUIN LOCAL HEALTii DISTRICT <br /> 1601 E. Haze 1 L o�n , P .O . Rox 2009 <br /> SLockton , CA 95201 466-6781 <br /> UCT 40 10/86 <br />