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0 0 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name; {Ilm�s ; •� <br />G y <br />Facility Address: *12)Is <br />Telephone: V S0G 3715 <br />Person Fling <br />Report <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 13of 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 an unauthorized (leak) release. (Yes in Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tank 1, and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank I Amount �T--J (;4 TFaIymPT=k <br />2. <br />198 <br />3. <br />4_ ENVIROMENTAL HEALTH <br />FERMI I/SERVICES <br />5. <br />Additional dates/amouots 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 submitted within 15 days of the end of each <br />quarter. <br />Quarter I - January --> ------J. <br />March <br />�QJartcr--2- --April --> June—' <br />Quarter - July --> September <br />Quarter 4 - October --> December <br />Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Haze]L )n, P.O. [lox 2009 <br />UCT 40 10/86 Stockton, CA 95201 466-6781 <br />