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�. �. 1-01 <br /> INVENTORY RECONCILIATION <br /> QUARTERLY zSUMMER REPORT FORM <br /> Facility Name: eUie6) Tangy: # Size Product <br /> Facility Address: l�3 •_)/ 6-7�__ �d <br /> Telephone: _(j�C`L_ �r_� __.._------ <br /> Person Filinq^ �� / <br /> Report s R1L��e.Y1�J _ <br /> VI hereby certify under penalty of perjury that all inventory <br /> variations for the above mentioned facility were within the <br /> allowable limits for this quarter. (No in Column 13 of the <br /> Inventory Reconciliation Sheet. ) <br /> Inventory variations exceeded the allowable limits for this <br /> quarter. I hereby certify under penalty of perjury that <br /> the source for the variation was not due to an unauthorized <br /> ( leak ) release. (Yes in Column 13 of the Inventory Recon- <br /> ciliation Sheet. ) <br /> List date, tank #, and amount for all variations <br /> that exceeded the allowable limits. <br /> Date Tank. # Amount <br /> 1. ------------ -------- ----------- <br /> 3. ------------ -------- ----------- <br /> 4. ------------ --------- ----------- <br /> 5. ------------ -------- ------------ <br /> Additional dates/amounts shall be continued on a <br /> separate sheet of paper and attached. <br /> If the source of the variation which exceeded allowable <br /> limits was due to a leak the incident shall be reported <br /> to S.J.L. H. D. Environmental Health within 24 hours and <br /> an unauthorized release report submitted. <br /> The quarterly summary report shall be submitted within 15 days <br /> of the end of each quarter. <br /> Quarter 1 - January --> March <br /> FICEWE0Quarter 2 - April > June <br /> Quarter 3 - Jul --f September <br /> Quarter 4 - October - ec JAN 61989 <br /> Send to SAN JOAQUIN LOCAL HEALTH DISTIFpATDNMENTALHEALTH <br /> 1601 E. HAZELTON, P. O. ROX 200RERMIT/SERVICES <br /> STOCKTON. CA 95201 466-67E31 <br />