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J <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> Faeiliq Name: �5ouTH GCttATTu ono) i FCIEl. n Sank Pro.,uct <br /> O 0 ep <br /> tEaeil[tr Addrnaat ''ins s- EsuloM a�8 a o R <br /> -Gn/on, ea Fs3zo ' 3 ' S 600 uv <br /> Telephone: -1339 <br /> Person Filing <br /> Reportl • GizIr- Fta <br /> I 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. (Ho in Colum I3of the inventory Reconciliation Sheet) <br /> Iaveatocy varistioas exceeded the allowable limits for this quarter. I <br /> hereby certify under penalty of pgrjury that the source for the variacion <br /> was not due to An unauthorised (leak) releiae. (yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List dater tack fr and amount for all variations that exceeded the <br /> allowable liwita_ - <br /> p-ata Amount <br /> / ouot <br /> 1. E RECEIVr D . <br /> 2. J U L 0 3 1990 <br /> 3• ENVIRONMENTAL HEALTH <br /> 4. PERMIT/SERVIC-ES <br /> Additional dates/aawuots shall be continued on a separate sheet of -� <br /> paper and attached. <br /> If the source of the variation which. exceeded allowableE limits <br /> was due Health <br /> to <br /> a leak the incident shall be reported to S .J .L.H.D. <br /> within 24 hours and an unauthorized 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 /> I D- April --> June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --> December <br /> Send to: SAN JOAQUIN LOCAL HEALTIi UIS•1HICT <br /> 1601 K. 1i3zc1t(" 1 , P .O. Box 2U07 <br /> Stockton , CA 95201 466-6161 <br /> tICT 40 10/86 <br />