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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPIRT FORM <br /> Facility Name: rAPNFr_TF SMA Tank I Size. roduet <br /> • 1 1000 GAL UNLEAD GAS <br /> laeiIiCy-*Addcess: _18600 CORRAL HOLLOW RD 2 1000-GAL. DI 77 <br /> TRACY CA 95378 01105 <br /> Telephone : 415 455 5918 <br /> Person Filing <br /> Report Nngm FICTRR <br /> QL 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 Colu® 11 of the Inventory Reconciliation Sheet) <br /> Lnventocy variations exceeded the allowable limits for this quarter. I <br /> bereby 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 /> Lpventory Reconciliation Sheet) <br /> List date, tack P, and amount for all variations that exceeded the 4 <br /> Allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2. _- I <br /> 3. <br /> 4. <br /> 5� <br /> Additional dates/amounts shall be continued on a separate sleet 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 unauthorised release report submitted. <br /> The quarterly summary report shall be submitted within 15 days of the and of each <br /> quartet. <br /> Quarter 1 - January --> March <br /> Quarter 2 - April --> June <br /> Quarter ) - July --) .September <br /> Quarter 4 - October 'December <br /> Send cc: i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. hazeltnn • P .O . Box 2009 <br /> Stockton . CA 95201 466-6761 1 <br /> ;T 40 10/86 <br />