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INVENTORY RECONCILIATION OCT 17 1988 <br /> QUARTERLY SUMMARY REPORT FORM LN1-RONMEN-iAL :;EALT!I <br /> PERMIT/SERVEE9 <br /> Facility Name: GEWEKE FORD <br /> 1045 So. ero ee T <br /> ank <br /> FaciIit Address: <br /> y P.o. Box luo <br /> LOIlI. ra 9594 <br /> Telephone : _IZOA) X34-65nn <br /> Person F 8 <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 far this <br /> / <br /> quarter. (No La Column 13of the Inventory Reconcilimtion 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) rel"ne. (Yes in Column <br /> Inventory Reconciliation Sheet) 13 of the <br /> I — <br /> j List date, tack i, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank f Amount <br /> 2. <br /> 3. <br /> 4. — � <br /> S. <br /> Addetiomzl dates/amounts shall be continued on a separate sheet of <br /> Paper and attached. <br /> If the source of the variation which. eaceeded allowable limits was due to <br /> a leak the incident shall be reported- to $ ,J , L. H . D. Environmental within 24 hours and an unauthorized Health <br /> re Lease report submitted., <br /> The quarterly summary report shall be submitted withi 15 days of he end of each <br /> quarter. <br /> Quarter 1 - January --) March <br /> Quarter 2 - April --) June <br /> Quarter 3 _ <br /> July --) sep(cmher <br /> Quarter 4 - October --> rkcember <br /> Send co: SAN JOAQUIN LOCAL HEALTH 0IS'1'RIC'1' <br /> 1601 E. Hazelrtai , P .O . Itux 200q <br /> CT 40 10/$6 Brockton , CA 95201 466-67bl <br />