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awl O <br /> INVENTORY RECONCILIATION U <br /> QUARTERLY SUMMARY REPORT FORM JUL 2 0 1987 <br /> ENVIROM ENTAL HEALTH <br /> Facility Name: �6�rf_ Fort D tank i oduct <br /> KBO � Cid 5 <br /> Facility;Address: ioY� s �i/FPiiIEF_ ac u sr", o <br /> Telephone : <br /> Person Filing <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 /> E] Inventory variations exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> vas not due to an unauthorized (leak) releise. (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 /> Date Tank It Amount <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> S. <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 Health <br /> Within 24 hours and an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within IS days of the end of each <br /> quarter_ <br /> Quarter 1 - January --> March <br /> lartcr D - April --> June <br /> Quarter 3 - July --) September <br /> Quarter 4 - October --) 0comber <br /> Send Co: SAN JOAQUIN LOCAL HEAL1'li DIS-l-R1CT <br /> 1601 E . llazelLoll , P .O . BOX 1009 <br /> Stockton , CA 95201 466 -6781 <br /> LILT 40 10/ 86 <br />