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ti <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />.Facility Name: /�a kil ~A"d k Not At <br />Facility Address: <br />Telephone: X04 4 <br />Person Filing /n� <br />Report ( qvr) <br />9 5. <br />5 <br />F E B 1 8 1992 <br />ENVIRO, .. AL HEALTH <br />PERM11/at.RVICES <br />Tank I Site Product <br />1- Bow 0 5N� <br />>�1 <br />�L hereby certify under penalty of perjury that all inventory varistioas for <br />the above mentioned facility were within the allowable Limits for this <br />Quarter. (No is Column 13 of the Lavencocy Reconciliation Sheet) <br />Lavencocy variations exceeded the allowable Limits for this Quarter_ I <br />hereby certify under penalty of perjury that the source for the variation <br />was aoC due Co as unauthorised (leak) release. (Yes is Column 13 of the <br />Inventory Reconciliation Sheet) <br />List date. tank f. and aa.ouat for all variations that exceeded the <br />allowable limits_ <br />Date Tank I Amount <br />Additional dates/amounts chatl be continued on : separate aheec of <br />paper and attached - <br />Lf the source of the variation whichexceeded allouable limits was due to <br />a leak the incident shall be reported to S.J.L.H.D. Environmental Ilcalcti <br />Within 24 hours and an unauthoritcd release report submitted. <br />The quarterly sussary report shall be submitted within IS days of the end of cacti <br />quarter. <br />Quarter 1 Jaauwry --) starch <br />Q•.arcer 2 - April --> Jane <br />Quarter 1 - July --) ]eptcmbcr <br />�4 - Octobcr --> Occomhcr <br />Send CO: SAN JOAQUIN LOCAL HEAI.I'li 0IS'I'RIC'1' <br />IDOL E. Hazelti.o, P.O. Itns '7..009 <br />SLockcon. CA 95201 466-67b1 <br />40 10186 <br />t <br />