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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: rADNFGTF wRA Yank I Size. Product <br /> ' 1 1000 GAL UNLEAD G <br /> lfatility,Addreus _13600 CORRAL HOLLOW RD 2 * 1000 GAL DI <br /> TRACY CA 95378 01105 <br /> Telephone: 415 455 5918 <br /> Person Filing <br /> Report NnpM FogTFR <br /> QI hereby certify under penalty of perjury that all inventory variations for <br /> the above mentioned facility uere within the allowable limits for this <br /> quarter- (No in Column 13 of the Inventory Reconciliation Sheet) <br /> 0 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 as unauthorised (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> Gist date. tank IF, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Yank P Amount <br /> z- OCT 4 1988 <br /> 3. <br /> 4. E^JViR0,MVIENTAL HEALTH <br /> PERMIT/SERVICES <br /> 5. <br /> Additions.'. dates/aswUots 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 Hcalth <br /> Within 24 hours and an unauthorised release report submitted. <br /> The Quarterly summary report shall be submitted within 15 days of the end of each <br /> Quarter. <br /> i <br /> Quarter 1 - January --> March <br /> Quarter 2 - April --) June <br /> Quarter 3 - July --) .September <br /> Qarter 4 - October --) 'Dkccmber <br /> Send to: i SAN JOAQUIN LOCAL HEAL1'li DISTRICT <br /> 1601 E . HaZelLOn , P .O . BOX 2009 <br /> SLockton , CA 95201 466-6761 1 <br /> ,T 40 10/86 <br />