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r <br />INVENTORY RECONCILIATIOND �� n� <br />QUARTERLY SUMMARY REPORT f aI <br />O <br />fill rw n <br />Facility Names <br />Facility •Address: 14971 N. Hwy. 88 <br />�v�.. Vr. VViTV <br />Telephone: <br />Person Filing <br />Report <br />Tank i-1- 11 ILMU Product <br />VVIR <br />R <br />/rU Din, -s'i <br />I hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable limits for this <br />quarter. (No in Column 13 of the Inventory Reconciliation Sheet) <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 ao unauthorized (leak) release. (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 E Amount <br />2. <br />3. <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 allowable limits was due to <br />AL 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 15 days of the end of each <br />quarter. <br />Quarter 1 - January --) March <br />Quarter 2 - April --> June <br />Quarter 3 - July --> September <br />Quarter 4 - October --> December <br />Send co: SAN JOAQU I N LOCAL HEALTH DISTRICT <br />1601 E. Hazel on , P.O. Rox 2009 <br />Stockton, CA 05201 460-6781 <br />T 40 10/66 <br />