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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT PORN <br />raciuty Haase: Cjqu�-oelvm ill,-VlvjyY r6n,& <br />raeility,Address: 38S'LU/3aT Cr2/9/J7l/N/-= 2D <br />7Q14dy X9 977372 <br />Telephone: 2a9 - 835- 8926 <br />Person Filing <br />Report le,W, YYl/LLle;,9g ✓ �GGL <br />Tank / Size Product <br />1 hereby certify u„dcr pcaalty ui perjury that all inventory variations for <br />the above oeationed facility were within the allowable limits for this <br />quarter. (Ho in Column IJ of the Inventory Reconciliation Sheet) <br />Inventory varistioaa exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the source for the variatioa <br />vas not due to an unauthorized (leak) release. (Yee in Col— 13 of the <br />Inventory Reconciliation Sheet) <br />List date, tack i, wad amcvJnt for all variations that exceeded the <br />allowable limits. <br />Date Tank It Amount <br />1.P ti <br />Z- APR v ` <br />3. ENVIRO, f <br />UE.vTAL HEALTy <br />4. FERMfT/SERVICES <br />5. <br />Additional dates/aaaouats shall be continued on a rclsarate she_t o: <br />paper and atczched. <br />If the source of the variation which.exceeded alio-oable limits was, due to <br />it leak the incident shall be reported to S.J.L.H.D. Envirorui�zntzl Health <br />Within 24 hours and an un2uthorixed release report ■uhr:fitted. <br />The quarterly au-. ry report shell be submitted within 15 days of the end of each <br />quarter. <br />r <br />Quarter 1 - JAnuary --> YSrch <br />Quarter 2 - April -®> June <br />Quarter 3 - July --> Septeaher <br />Quarter 4 - October Oeccvber <br />Send to: SAN JOAQUIN LOCAL HLALTH DISTRICT <br />1601 L. Hazell.4M. P.O. Box 2009 <br />SLockton. CA 95201 466-6781 <br />UCT 40 10/86 <br />