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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Facility Name: rAFNFCTF wuA Tank f Pcoduet <br /> * 1000 GAL UNLEAD <br /> Pacility;Addcesa: _1ft600 CORRAL HOLLOW RD 2 1000.GAL DIESFL <br /> .TRACY CA 95378 01103 Telephone : 415 455 5918 <br /> Person Filing <br /> Report NQRM FnSTFR <br /> Q 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. I <br /> hereby certify under penalty of perjury that the source for the variation <br /> was not due to as unauthorized (leak) release. (Yes in Column 13 of the <br /> inventory Reconciliation Sheet) <br /> List date, tank 0, and amount for all variations eha ceded the ' <br /> allowable limits. 1 ;Z% � -- SII <br /> Dale Tank f Amount <br /> 1, APR b 498c� <br /> 2. _ ENVIROMENTAL HEALTH I <br /> FERMIT/SERVICES; <br /> 3. , <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> Et the source of the variation whichexceeded 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 aad 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 1 - January --> March <br /> Qisrter 2 - April --) June <br /> Quarter 3 - July --) .Septewher <br /> Quarter 4 - October --) •becember <br /> Send to: i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . s:azellun . P .O . BOX 2009 <br /> Stockton . CA 95.201 466-6761 u <br /> T 40 10/86 <br />