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ROT 7 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM ENVIROMENTAL HEALTH <br /> I ERMIT/SERVICES <br /> Facility Name: rzoPNFCTB cveA Tank 1 Size Product <br /> 1000 GAL UNLEAD GAS <br /> Facility,Address: ,1600 CORRAL HOLLOW RD ' 1000 -GAL DI <br /> TRACY CA 95378 01105 " <br /> Telephone : 415 455 5918 <br /> Person Filing <br /> Report NQRM FASTFR <br /> QI 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 I3 of the Laventory 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 unauthorized (leak) releise. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date. tank P, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank I Amount <br /> 1. <br /> 2. j <br /> 3. <br /> 4. <br /> 5. <br /> Additional dates/amounts shall be contioued on a separate sheet of <br /> paper and actached. <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 end of each <br /> quarter. <br /> Quarter i - January March <br /> Quar - April --> June <br /> arter I July --> Septcmber <br /> Quarter October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . HaZeILIM , P .O . linx 2009 <br /> Stockton , CA 95201 466-6761 1 <br /> ;T 40 10/86 <br />