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i <br />I YE TORY RECONCILIATION <br />-- QUARTERLY SUMMARY REPORT FORK <br />clLity mane: _ �t �✓t ldr Q/i oma! <br />Facility,Addcesst <br />qs <br />Person Filing <br />Report •• <br />1, hereby certify under Penalty of perjury <br />the above mentioned facility were within the <br />+. } •r limits <br />. <br />i f Column 13of the Inventory Reconciliation,Sheet) <br />is laventOcy <br />Variations • t the allowable Limits <br />hereby T <br />in quarter. I <br />underpenalty <br />source for the <br />was not due variatioT <br />f so unauthorized (leek) rele�se. (yes in Column 13 of the <br />Inventory <br />:.. • .:: <br />econciliation Sheet) <br />for all variations that exceeded the <br />allowable limits. <br />2. <br />. <br />4- <br />5. <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 atlowable limits was due to <br />a leak the incident shall be reported to S•J.I,..D. Envico ntal ticalth <br />within 24 hours and an unauthorized release report submitted. <br />The quarterly summary report shall be submitted within 05 days of the end of each <br />quarter. <br />Quarter i - January --) M.'rch <br />Qesarter 2 - April --) Jugle <br />Quarter l - July --) September <br />Quarter 4 - October --) t),-ec•mbcr <br />Send to: SAN JOAQUIN LOCAL. HEALTH DISTRICT <br />160L !:. <br />140 In/tiG Stockton, CA 95201 4 6 0 - 6 7 b I <br />