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L1 i <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: 6 /�� F�2 Tank I Size. Product <br /> 6.¢s <br /> Facility<Address: /OY� 5 Ci/E?//lEF_ a u srE a <br /> Telephone ; <br /> Person Filing <br /> Report '3tc-FF wEQdE2 <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 /> E] Inventory variations exceeded the allowable limits for this quarter. 2 <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to an unauthorized (leak) releiee. (Yet 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 /> Dale Tank f Amount <br /> 1. <br /> 2. APR 41988 <br /> 3. �ENVIROM&,TAL HEALTH <br /> 4. FERMIT/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 allowable limits was due to <br /> a leak the incident shall be reported to S ,J . L. H . D . Environmental Ucalth <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 --) March <br /> Quarter 2 - April --> June <br /> Quarter 3 - July --) Scptcmher <br /> Quarter 4 - October --). December <br /> Send co: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 160L E . llazelLoll . P .O . BOX 2009 <br /> Stockton , CA 95201 466 -67bL <br /> IIGT 40 10/86 <br />