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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM <br /> FaicLUty Name: ��T�1 Co �fTy �on�ls�krCc� Tank <br /> Stze. Product <br /> l�cilit Addresst �� opo Sock��.z uu <br /> )'' _L30.G ES�nfoh Atm _ C o e.)r, / <br /> _f*'<CALDi.). C.q GS 32eo "'3j Oo <br /> Telephone : <br /> Person Filing <br /> Report <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 I7 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 /> was not due to an unauthorized (leak) releise. (Yes in Column IJ of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank 1, and amount for all variations that exceeded the � <br /> allowable limits. <br /> Date Tank / Amount <br /> 1. <br /> _-3. <br /> 4• OCT 5 5988 <br /> 5' FNVIRCNMENTAL HEALTH <br /> PERMIT!SERVICES <br /> Additional dates/amouatx shall be continued oa a separate sheet of <br /> paper and acrached_ <br /> If the source of the variation which. exceeded allowable limits was due to <br /> ■ 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 suoaary report shall be aubmittcd within 15 days of the end of each <br /> Qu.rtcr. <br /> Quarter 1 - Jaauary --) March <br /> Quarter 2 - April --> June <br /> aQuarter ) - July --> Scptcmhcr <br /> Quarter 4 October --> December <br /> Send Co: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. 11Jze I Lmmn • P .O . Box 2007 <br /> Stockton , CA 95201 466-67bl <br /> UGT 40 10/ 86 <br />