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INVENTORY RECONCILIATIOM <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Naa.e: aLt�(yt11�/ <br />Facility Address: /�L AJ Cl World. <br />5'*, Le 4. C- a -- <br />Telephone: 020 <br />Person Filing <br />Report <br />hereby certify under penalty of perjury that all inventory variations for <br />the above .cocioned facility were within the allowable limits for chis <br />Quarter. (No in Colum "Of the Inventory Reconciliation Sheet) <br />❑ Inventory variations exceeded the allowable limits for this quarter. L <br />hereby certify under penalty of perjury that the source for the variation <br />vas not due CO ao unauthorised (leak) release. (Yes in Column 13 of the <br />Isveatory Reconciliation Sheet) <br />List date, tank 1, and amownt for all variations that exceeded the <br />allowable limits. <br />Date Tank / AmounC <br />0 <br />RECEIVED' <br />JAN 2 3 1990 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />Additional date_/—o::C is a4alt Lz eac.tiaued on a :epa.-atc +heet or <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 IlcalCJ� <br />within 24 hours and an unauthorized release report submitted. <br />The Quarterly sus ry report shall be submitted within 15 days of the end of each <br />Quarter. <br />Quarter I - Janu.ry __) M.v cls <br />Q'u rtcr 1 - April <br />Quarter ) - July __) is p[emhcr <br />u rtcr G - October --) !>t ccmber <br />Send to: SAN JOAQUIN LOCAL HEAL -1.1i 0ISTRIC-1- <br />I601 1{. I!azt• I t jm • 1' .O. Itn.e Z(1(19 <br />1 40 10/M6 SLockton• CA 95201 466-67b1 <br />' <br />