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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Name: CnL/F6RA)1I4 N/CNfoXY 17.47J7oe <br />Faeilier,Address; 3Ss�/,�lFSTdRANTL/A/!r <br />"'_T,R14AY 69 9S37L <br />Telephone: 20l - 835- 8910 <br />Person Filing <br />ReporC le -60, M11,4/CN)V 'c Y46Z <br />Tank f Size Product <br />'/ 00 C 4NGF F C <br />E 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 Colu® 13 of the loventory 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 so unauthorized (leak) release. (Tea in Column 13 of the <br />Iaveatory Reconciliation Sheet) <br />List date, tank fs and amount for all variations that exceeded the <br />allowable limits. <br />Date Tank f Amount <br />2. O C T 6 1988 ((("VUVUVUIIII' <br />3. ENVIROPJMENTAL HEALTH <br />4. PERMIT / SERVICES <br />5. <br />Additional dates/ -ivatz shall be continued on a separate M'Vzet of <br />paper and attached. <br />Lf the source of the variation which.exceeded allowable lioita wan due to <br />a leak the incident shall be reported to S.J.L.H.D. EnvirommentiA Ncalth <br />Within 24, hours and an unauthorircd release report subairted. <br />The quarterly suc,macy report shall be submitted within 15 days of the end of each <br />Quarter. <br />Quarter I - January --> March <br />2 - April --> June <br />Quarter 3 - July --) Scptcmhcr <br />Qua - October --) December <br />Send co: SAN JOAQUIN LOCAL HEAL3'li OIS"I*RICT <br />1601 E. Hazelton. 1'.0. Box 2009 <br />Stockton, CA 95201 466-6781 <br />IGT 40 10/86 <br />I <br />