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INVENTORY RECONCILIATION <br /> QUARTERLY SUMMARY REPORT FORM JAN <br /> NVIROMENTA VICES <br /> FaeiLity Name: scu-rH 00,04 Flo=n FuFi_ c r, . Tank I Ste - product <br /> 10 Ca , __5LkPCV Innl, <br /> racility'-'Address: 130 5 Ecca /o.n Ase t) ( l x✓ <br /> .. �•,jcrAIngl Ct! 9t.2077 <br /> Telephone : zoq/ 5538 -1334 <br /> Person Filing <br /> Report DQV\iCI , LRICFIK� <br /> 0 L 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 Columo Il of the Leventory Reconciliation Sheet) <br /> ElInventory 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) relelse. (Yes in Column 13 of the <br /> Inventory Reconciliation Sheet) <br /> List date, tack /, and amount for all variations that exceeded the <br /> allowable limits. <br /> Date Tnnk I Amount <br /> 1. <br /> 2. <br /> f <br /> ]. <br /> 4. <br /> S. <br /> Additional dates/amouots 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 /> Quarter. <br /> Quarter I - L ouary --) March <br /> Quarter 2 - April --) June <br /> Quarter ) - July --) Septcmher <br /> Q.arcer 4 - October --) December <br /> Send co: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. IiazelLon . P .O . Box 2009 <br /> Stockton , CA 95201 466-6761 <br /> UCT 40 10/ 86 <br />