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J M <br /> INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM P��-V StN <br /> E���ER�n+c 15�R <br /> Facility Names SOcarI� Cdut TY FooD cr cq Tank f Sire. <br /> Product <br /> FaeilLty,Addresaf 1 � 00p c2 tlul <br /> L3bS talo a�E to oo•a . <br /> FSCwc t."'3 rm yt 20 , <br /> : <br /> Tele hone <br /> P 2oq l_ R 3 R - /PS x q <br /> Person Filing <br /> Report hcw..eA <br /> QI 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 /> ElIoventocy 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 unauthorized (leak) releise. (Yes in Colum 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tank f, and amount for all variations that exceeded the <br /> allowable limits_ <br /> Date Tank f Amount <br /> 1. <br /> 3. <br /> 4. <br /> Additional daces/amounts shall be continued on a separate sheet of <br /> paper and attached. <br /> If the source of the variation which. excecded allowable limits was due to <br /> a leak the incident shall be reported to S .J . L.H . D. Environmental Ucalch <br /> within 24 hours and an unauthoriscd release report submitted. <br /> The Quarterly summary report shall be submitted within 15 days of the end of each <br /> Quarter. <br /> Quarter I - Jaouary --) March <br /> Qarter 2 - April --> June <br /> Quarter I - July --) September <br /> Quarter 4 - Occober --> Deccmber <br /> Send co: SAN JOAQUIN LOCAL HEALTIi DISTRICT <br /> 1601 E , liazelLoll . P .O . Box 2009 <br /> SLockcon , CA 95201 466 -6761 <br /> Uc:T 40 10/ H6 <br />