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INVENTORY RECONCILIATION JAN 10 1989 <br /> QUARTERLY SUMMARY REPORT fORMEN PERMIT%E4L,HEALTFl <br /> faeLLity Name: r..L� l, 9. E[ c.,. Tank IStca <br /> Product <br /> 1 io. <br /> fieilio3O sti u <br /> C,y-'Addraus 1. <br /> Telephone : t 8 - 13 3'i <br /> 3 Lde— <br /> - °e . uu lea ded <br /> Person Filing <br /> Report 0 �-e,y <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. (No in Column 13 of the Inventory Reconciliation Sheet) <br /> ❑ 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 an ueauthorixed (leak) release. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List dates tank /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> 3. <br /> 4. <br /> 5. ., <br /> Additional dates/amounts shall be continued on a separate sheet of <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 Health <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 /> Quartcr_ <br /> Quarter I - January --) March <br /> Quarter 2 - April --) June <br /> Quarter 3 - July --> September <br /> Quarter 4 - October --) December <br /> Send to: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E . HazelL+ni , P .O . Hos 2009 <br /> Stockton , CA 95201 466-6761 <br /> ucT 40 10/86 <br />